临床小儿外科杂志

目的总结和介绍本院腹腔镜下儿童肠重复畸形的治疗体会。方法回顾2013年3月至2016年11月本院收治的24例儿童肠重复畸形的病例资料,其中男11例,女13例,最小年龄5天,最大12岁,平均年龄3岁1个月, 3岁以下患儿17例。胃重复畸形1例,十二指肠重复畸形1例,空肠重复畸形3例,回肠重复畸形10例,回盲部重复畸形9例。结果 24例均完成手术,12例行腹腔镜辅助下肠重复畸形切除术,平均手术时间(78.3±27.3)min,5例行完全腹腔镜下肠重复畸形切除术,平均手术时间(114.0±13.9)min,7例行腹腔镜探查后中转开腹手术,平均手术时间(115.7±39.8)min,三组间比较差异有统计学意义(F=4.581,P=0.022)。开始进食时间,完全腹腔镜组(5.2±0.4)d,早于腹腔镜辅助组(6.1±0.9)d和腹腔镜中转开腹组(6.4±0.8),三组间比较差异有统计学意义(F=3.572,P=0.046)。完成进食时间,完全腹腔镜组(7.4±0.5)d,早于腹腔镜辅助组(8.3±1.1)d和腹腔镜中转开腹组(9.3±1.3)d,三组间差异有统计学意义(F=4.932,P=0.018)。三组患儿平均住院日(10.5±2.7)d,完全腹腔镜组短于腹腔镜辅助组和腹腔镜中转开腹组,三组间差异有统计学意义(F=3.643,P=0.044)。所有患儿平均随访时间(19.2±15.8)个月,无并发症,无复发。结论腹腔镜下治疗儿童肠重复畸形是一种较好的手术方法,具有诊断兼具治疗作用,创伤小,伤口美观,值得推广。

Objective Objective To summarize the experiences of laparoscopic management for pediatric alimentary tract duplication. Methods A retrospective review was conducted for medical records of 24 intestinal duplication patients. The average age was 37 months(5 days to 12 years)and 17 patients were aged under 3 years. Among them, there were gastric duplication(n=1), duodenal duplication(n=1), jejunal duplication(n=3), ileal duplication(n=10)and ileocecal duplication(n=9). Results All of them underwent surgery. Laparoscopy-assisted resection of duplication was performed in 12 children with an average operative duration of(78.3±27.3)min. Laparoscopic resection of duplication was performed in 5 children with an average operative duration of(114.0±13.9)min. Laparoscopic exploration was converted into laparotomy in another 7 cases. The average hospitalization period was(10.5±2.7)days. All patients were cured without complication or relapse during an average follow-up period of(19.2±15.8)months. Conclusion Laparoscopic excision of duplication is mini-invasive and effective. And it is worth wider popularization in clinical practice.

引言
1 材料与方法
2 结果
3 讨论

表1 手术方式与基本资料(x^-±s)<br/>Table 1 Surgical approaches and basic profiles(x^-±s)

表1 手术方式与基本资料(x^-±s)
Table 1 Surgical approaches and basic profiles(x^-±s)

图1 腹腔镜辅助下操作:腹腔镜下找到回盲部囊肿型肠重复畸形并将其经脐部稍扩大的切口处提出,见囊肿位于浆膜下,与正常肠管部分共壁,直视下电刀小心剥离囊肿并修补浆肌层。<br/>Fig.1 Laparoscopy-assisted resection of duplication: Intestinal duplication of ileocecal cyst was detected under laparoscopy and extracted out of enlarged umbilical incision. Cyst was located under serosa and it partially shared a wall with normal bowl. Then an electric surgical knife was used for removing cyst before repairing serosa.

图1 腹腔镜辅助下操作:腹腔镜下找到回盲部囊肿型肠重复畸形并将其经脐部稍扩大的切口处提出,见囊肿位于浆膜下,与正常肠管部分共壁,直视下电刀小心剥离囊肿并修补浆肌层。
Fig.1 Laparoscopy-assisted resection of duplication: Intestinal duplication of ileocecal cyst was detected under laparoscopy and extracted out of enlarged umbilical incision. Cyst was located under serosa and it partially shared a wall with normal bowl. Then an electric surgical knife was used for removing cyst before repairing serosa.

图2 全腹腔镜下操作:腹腔镜下找到位于距离回盲部约40 cm的囊肿型肠重复畸形,将其悬吊于腹壁后在腹腔镜下予以剥离并修补浆肌层。<br/>Fig.2 Laparoscopic resection of duplication: intestinal duplication of ileal cyst was located at around 40 cm away from ileocecal region under laparoscopy. Then it was suspended to abdominal wall. After removing cyst, serosa was repaired under laparoscopy.

图2 全腹腔镜下操作:腹腔镜下找到位于距离回盲部约40 cm的囊肿型肠重复畸形,将其悬吊于腹壁后在腹腔镜下予以剥离并修补浆肌层。
Fig.2 Laparoscopic resection of duplication: intestinal duplication of ileal cyst was located at around 40 cm away from ileocecal region under laparoscopy. Then it was suspended to abdominal wall. After removing cyst, serosa was repaired under laparoscopy.

表2 手术方式与病例数[n(%)]<br/>Table 2 Surgical approaches and case number[n(%)]

表2 手术方式与病例数[n(%)]
Table 2 Surgical approaches and case number[n(%)]

表3 手术方式与术后恢复时间(x^-±s)<br/>Table 3 Surgical approaches and recovery time(x^-±s)

表3 手术方式与术后恢复时间(x^-±s)
Table 3 Surgical approaches and recovery time(x^-±s)

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备注

引言

1 材料与方法

2 结果

3 讨论

期刊信息

备注

引言

1 材料与方法

2 结 果

3 讨 论

期刊信息

2 结果

3 讨论