腹腔镜与传统术式治疗先天性肠旋转不良的效果对比

Comparison of the therapeutic effect of laparoscopic and traditional surgical treatment of congenital intestinal malrotation

目的探讨分析腹腔镜与传统开腹术式治疗先天性肠旋转不良的有效性及安全性。方法回顾性分析2013年1月—2017年12月本院收治的200例先天性肠旋转不良患儿的临床资料,以手术方式不同分为腹腔镜组(98例)和开腹组(102例)。比较两组的术中指标(手术时间、术中出血量、手术应激时间)及术后指标(留置胃管时间、住院时间及胃肠道恢复时间),检测两组患儿手术前后B细胞、NK细胞以及CD3^+水平,比较两组的术后并发症情况及治愈情况。结果腹腔镜组的手术时间、术中出血量及手术应激时间均显著少于开腹组(P<0.05);腹腔镜组的留置胃管时间、住院时间以及胃肠道恢复时间均显著短于开腹组(P<0.05);手术后,腹腔镜组的B细胞及CD3^+水平显著高于开腹组(P<0.05);腹腔镜组的并发症发生率为7.14%,显著低于开腹组的17.65%(P<0.05);腹腔镜组的治愈率为100%,开腹组的治愈率为98.04%,比较差异无显著性(P>0.05)。结论与传统开腹式手术相比,腹腔镜手术治疗先天性肠旋转不良具有切口小、手术时间短、利于患儿康复、并发症少等优点。

Objective To investigate the efficacy and safety of laparoscopic and traditional laparotomy for treating congenital intestinal malrotation. Methods The clinical data of 200 children with congenital intestinal malrotation admitted to our hospital during January 2013 and December 2017 were retrospectively analyzed.Children were divided into laparoscopic group( n = 98) and the laparotomy group( n = 102) according to the different surgical methods. The intraoperative indexes( operative time,intraoperative blood loss,surgical stress time),postoperative indexes( indwelling gastric tube time,hospital stay,and gastrointestinal recovery time),levels of B cells,NK cells and CD3^+,postoperative complications and cure degree were compared between the two groups.Results The operation time,intraoperative blood loss and surgical stress time of the laparoscopic group were significantly less than those of the laparotomy group( P< 0.05). The time of indwelling gastric tube,hospitalization and gastrointestinal recovery in the laparoscopic group were significantly shorter than those of the laparotomy group( P < 0. 05). After operation,the B cell and CD3 + levels in the laparoscopic group were significantly higher than those in the laparotomy group( P<0.05). The complication rate in the laparoscopic group was significantly lower than that in the laparotomy group( 7. 14% vs 17. 65%,P < 0. 05). The cure rate of the laparoscopic group was higher than that in the laparotomy group,with no statistic difference( 100% vs 98.04%,P>0.05).Conclusions Compared with traditional laparotomy surgery,laparoscopic surgery has the advantages of small incision,short operation time,good rehabilitation for children,fewer complications and so on in treating congenital intestinal malrotation.