多学科联合治疗儿童难治性消化道多发息肉的疗效分析

目的探讨多学科联合,腹腔镜辅助下小肠镜切除消化道难治性息肉的临床价值及安全性。方法回顾性分析湖南省儿童医院2008—2018年收治的21例难治性消化道息肉患儿的临床资料,所有患儿在腹腔镜辅助下行小肠镜下深部息肉切除术。结果21例患儿中男童14例,女童7例,平均年龄(7±2.1)岁。病因:黑斑息肉综合征(Peutz-Jeghers syndrome,PJS)15例,家族性多发性腺瘤样息肉1例,单纯小肠息肉5例。病理检查结果:错构瘤8例,幼年型息肉9例,腺瘤性息肉1例,增生性息肉3例。临床表现:反复发生肠套叠16例,不完全性肠梗阻5例。16例经术前腹部B超明确诊断,5例经CT明确诊断。21例均在腹腔镜辅助下行小肠镜息肉切除术,其中2例为十二指肠水平段息肉,3例为高位结肠息肉,其余均为小肠息肉。共切除息肉143粒,最大者5 cm×4.5 cm,均留标本送病理检查。术中1例广基巨大息肉5.5 cm×5 cm无法内镜下切除改外科手术治疗。术中因巨大息肉予钛铗缝合3例,钛铗止血5例,术中穿孔较大转行腹腔镜下修补术2例。结论多学科联合治疗儿童难治性消化道多发息肉可获得满意疗效,仅有极少数患儿需外科手术治疗。该治疗方法的并发症少、安全可靠,是值得推广的联合微创治疗模式。

Value of multidisciplinary cooperation in therapy refractory digestive tract polyps in children

Objective To explore the clinical value and safety of multi-disciplinary cooperating laparoscopic assisted enteroscopic polypectomy for pediatric refractory digestive tract polyps.Methods Retrospective analysis was performed for clinical data of 21 children of pediatric refractory deep digestive tract polyps undergoing laparoscopically assisted enteroscopic polypectomy from 2008 to 2018.Results There were 14 boys and 7 girls with an average age of(7±2.1)years.The causes were Peutz-Jeghers syndrome(n=15),familial ademomatous polyposis(n=1)and intestinal polyps(n=5).And the pathological diagnoses were hamartoma(n=8),juvenile polyps(n=9),adenomatous polyps(n=1)and hyperplastic polyps(n=3).Clinical manifestations included recurrent intussusception(n=16)and incomplete intestinal obstruction(n=5).And all children underwent laparoscopic-assisted enteroscopic polypectomy,including duodenal horizontal segment polypectomy(n=2)and upper colon polypectomy(n=3).The remainder underwent small intestine polypectomy.A total of 143 polyps were removed and submitted for pathological examinations.The maximal diameter of polyp was 5×4.5 cm.One patient with broad-based giant polyp(5.5×5 cm)that could not be removed endoscopically was finally operated.Three cases of giant polyps were sutured with titanium clip while 5 cases of polyps were treated with titanium clip for hemostasis.Two cases finally underwent laparoscopic repair because of intestinal perforation intraoperatively.Conclusion Under the guidance of abdominal CT and ultrasound,laparoscopic assisted enteroscopic polypectomy has fewer complications and more safety so that more satisfactory clinical outcomes may be achieved.Only few cases require surgery.Therefore it is worthy of promoting multidisciplinary cooperation plus mini-invasive treatment.