腹腔镜下整复28例难复性肠套叠临床疗效分析

【目的】探讨腹腔镜手术在难治性小儿肠套叠治疗中的应用。【方法】28例接受腹腔镜治疗小儿肠套叠，气管插管全麻，建立人工气腹，置入腹腔镜探查病变情况并采取相应的手术方式。【结果】28例中2例因肠套叠反复发作行腹腔镜手术探查治疗，探及回盲部游离为反复肠套叠的原因，并行回结肠固定。25例患儿因空气灌肠失败行腹腔镜手术治疗，结果20例腹腔镜下直接用无损伤钳操作复位成功；3例肠套叠已自行复位，其中1例合并有美克尔憩室；1例腹腔镜下直接用无损伤钳操作复位失败，术中加用空气灌肠辅助成功；1例中转开腹。3例起病超过48h无空气灌肠指征，在腹腔镜下直接用无损伤钳操作复位成功。【结论】腹腔镜手术治疗空气灌肠整复失败的小儿肠套叠是一种安全有效的微创疗法，并可使假阳性患儿避免开腹手术，及时发现多发性肠套叠及发现其它先天性肠管畸形；对频繁发作的肠套叠病因及治疗亦有帮助。

Discussion on the Reduction of 28 Patients with Refractory Intussusception by Laparoscopy

[Objective] To explore the application of laparoscopic operation in the treatment of refractory intussusception in children. [Methods] Patients underwent tracheal intubation under general anesthesia. Arti- ficial pneumoperitoneum was established. Laparoscope was inserted to probe the pathological changes. Corre- sponding laparoscopic operation method was adopted. [Results] Twenty eight pediatric patients with intussus- ception underwent !aparoscopy. Two patients with recurrent intussusception were treated by laparoscopic ex- ploration, and free ileocecal junction as the cause of recurrent intussusception was found, and then ileocolon was fixed. Twenty five patients who failed to air enema received laparoscopic operation. Among them, 20 ca- ses had successful reduction by directly using nontraumatic forceps under laparoscope. Among 3 patients with automatic reduction, 1 patient was complicated with Meckel＇s diverticulum, and 1 patient failure to the reduc- tion with direct nontraumatic forceps was treated with additional air enema successfully, and 1 patient was con- verted to laparotomy. Two patients without the indication at 48h after the onset of the disease were successful- ly reset by directly using nontramatic forceps. [Conclusion] Laparoscopie operation is a safe, effective and min- imally invasive method for treatment of pediatric intussusception failure to air enema, and can help pediatric patients who are false positive avoid laparotomy. It can help detect multiple intussusception and other congeni- tal intestinal anomalies in time. It is also beneficial for the etiological study and treatment of frequent recur- rence intussusception.