经脐单孔腹腔镜手术治疗小儿肠套叠疗效分析

Clinical research of transumbilical single-port laparoscopic treatment for pediatric intussusception

关键词:  肠套叠  单孔腹腔镜  儿童

Key words:  intussusception  single-port laparoscopy  child

摘要:

目的 探讨经脐单孔腹腔镜手术治疗小儿肠套叠的可行性及临床疗效。方法 收集2017年12月至2019年6月经脐单孔腹腔镜手术治疗小儿肠套叠38例的临床资料。手术方式经脐部切口放置Trocar建立气腹，置入单孔带操作通道0°腹腔镜，探查肠套叠，无损伤钳操作使之完全复位。肠套叠复位后，如果发现肠管畸形，可扩大脐部切口，将病变肠管提至腹腔外切除。同时收集同期行传统多孔腹腔镜肠套叠手术的24例患儿的临床资料，比较两组患儿手术时间、术中出血量、术后住院时间及切口美观满意度评分。结果 两组患儿均顺利完成手术，与多孔腹腔镜组相比，单孔腔镜组手术时间缩短[（32.4±8.6）min vs.（40.6±9.8）min，P<0.05]，出血量减少[（5.5±1.5）mL vs.（8.6±2.2）mL，P<0.05]，术后住院时间明显缩短[（4.6±1.2）d vs.（6.2±1.4）d，P<0.05]，切口美观满意度评分明显升高[（4.2±0.8）分vs.（3.2±0.7）分，P<0.05]。随访6个月~2年未见肠套叠复发。结论 经脐单孔腹腔镜手术治疗小儿肠套叠是一种安全、有效的手术方法，创伤小，恢复快，手术时间短，并且能达到更好的美观效果。

Abstract:

Objective To investigate the clinical value of transumbilical single-port laparoscopic reduction of intussusception in children. MethodsA retrospective analysis was performed to evaluate outcomes of 38 children with intussusception, who were treated by transumbilical single-port laparoscopical reduction form December 2017 to June 2019. Pneumoperitoneum was created following a Trocar introduced via umbilical incision. The 0° single-port laparoscopy and non-destructive pliers were inserted. And intussusception was completely reduced. After reduction of intussusception, if malformed intestine was found, the umbilical incision was extended and the malformed intestine was excised outside the abdominal cavity. During the same period, 24 children received multi-port laparoscopic surgery. The operation time, blood loss, postoperative hospitalized time and aesthetic satisfaction score were compared between the two groups. Results Both groups were operated successfully. Compared with the multi-port laparoscopic surgery group, the single-port laparoscopic surgery group had shorter operation time[(32.4±8.6) min vs. (40.6±9.8) min, P<0.05], less blood loss[(5.5±1.5) mL vs. (8.6±2.2) mL, P<0.05], and shorter postoperative hospitalized time[(4.6±1.2) d vs. (6.2±1.4) d, P<0.05]. The aesthetic satisfaction scores was higher in the single-port laparoscopic surgery group than that in the multi-port laparoscopic surgery group[(4.2±0.8) points vs. (3.2±0.7) points, P<0.05]. During a follow-up period of 6 months to 2 years, no recurrence of intussusception was noted. Conclusion The transumbilical single-port laparoscopy is safe and efficient for pediatric intussusception reduction. And it offers multiple advantages of mini-invasiveness, quicker recovery, shorter operative time and better cosmetic outcome.