通信作者:周承校,Email:zhouchengxiao1@12 com
目的 探讨经脐单孔法腹腔镜手术治疗小儿肠套叠的可行性及临床疗效。 方法 本研究收集了2012年7月至2015年5月间本院经脐单孔法腹腔镜治疗的36例急性肠套叠患儿的临床资料。经脐切口放入Tri-port后置入腹腔镜,建立气腹,反复使用无损伤钳交替缓慢并持续挤压套叠头部,直至套入部缓慢退出鞘部后,于升结肠或套入肠管处使用无损伤钳牵拉使之完全复位。 结果 36例患儿顺利完成手术,手术时间(40.4± 4)min,出血量( 0±0.5)mL,术后住院时间(6±1)d。腹腔镜下观察到被套入肠管复位后血供情况良好,小部分浆肌层撕裂。其中4例在复位中发现是Meckel憩室引起肠套叠,经脐扩大切口完成Meckel憩室切除+肠吻合术; 1例因复位困难将切口向上下端各延长1 cm后完成手术,术后无伤口裂开、迟发型肠穿孔等并发症。随访3个月未见肠套叠复发。 结论 经脐单孔法腹腔镜手术治疗小儿肠套叠是一种安全、有效、可行的手术方法,并发症少,创伤小,恢复快。
Objective To evaluate the feasibility of open reduction of pediatric intussusception through transumbilical single-port laparoscope. Methods During July 2012 and May 2015,36 cases of acute pediatric intussusceptions underwent open reduction through transumbilical single-port laparoscope. Umbilical incision was made for inserting Tri-port and then laparoscope for establishing pneumoperitoneum. Non-destructive pliers was used repeatedly for squeezing sleeve head to allow its exit from sheath. And ascending colon or affected intestine was completely reduced. Results Thirty-six cases of intussusception were successfully reduced. The estimated volume of blood loss was( 0±0.5)ml and postoperative hospital stay(6±1)days. Blood supply was restored for affected intestine and there was only a small area of seromuscular tear. There were 4 cases of Meckel's diverticulum intussusception. And umbilical incision was made for expanded resection and anastomosis. For one case with a difficult reduction,incision was extended for 1 cm at both upper and lower ends. There was no postoperative onset of wound gaping,delayed perforation or other complications. During a follow-up period of 3 months,no recurrence of intussusception was noted. Conclusion Transumbilical single-port laparoscopy is efficacious and safe for acute pediatric intussusception. And it offers multiple advantages of mini- invasiveness,quicker recovery,minimal incision and fewer postoperative complications.
