【摘要】 目的:总结腹腔镜手术治疗小儿急性肠套叠的手术经验。方法:2008年8月至2011年5月为36例空气灌肠复位失败或禁忌的肠套叠患儿行腹腔镜手术。腹腔镜直视下行肠套叠复位术,如发现复位困难,则行空气灌肠辅助复位。如复位仍失败,可经Trocar将吸引器头或细硅胶管插入肠套叠鞘部,注入生理盐水,在空气灌肠辅助下用无损伤抓钳牵拉回肠末端,整复肠套叠,复位后行腹腔镜阑尾切除术。如有肠坏死或器质性病变,则行肠切除、肠吻合术。结果:22例经空气灌肠辅助复位成功,8例经鞘内注入生理盐水辅助复位成功。30例复位成功的患者均行腹腔镜阑尾切除术;3例因肠坏死或套叠过紧无法在腹腔镜下复位,2例美克尔憩室,1例淋巴瘤,行腹腔镜辅助肠切除、肠吻合术。手术时间平均45min,腹腔镜阑尾切除术时间平均8min,术后48h肠功能恢复,平均住院5d。随访至今,未见复发及手术并发症发生。结论:腹腔镜肠套叠复位术结合空气灌肠、肠套叠鞘部注水可使绝大多数肠套叠复位,手术安全可靠,具有腹腔镜手术的微创优点,复位后行腹腔镜阑尾切除术,不做回肠固定,可有效防止肠套叠复发。更多还原

【Abstract】 Objective:To summarize the experience of laparoscopic surgery in treatment of acute intussusception for children.Methods:Thirty-six children with intussusception who were failed in or could not receive gaseous enema reduction underwent laparoscopic operation from Aug.2008 to May 2011.If it was difficult to reduce,gaseous enema reduction was applied.If after these procedures,reduction still could not be accomplished,the suction tubes or small sebific duct was inserted into intussuscipiens and physiological saline was injected.The no-damage grasping forceps were used to retract terminal ileum,which was assisted by gaseous enema.After reduction,laparoscopic appendectomy was performed.If intestinal necrosis or organic lesion were found,intestinal resection and anastomosis were performed.Results:The 22 cases of reduction were achieved by gaseous enema assisted reduction,8 cases of reduction were succeeded by injection of physiological saline into intussuscipiens.All the 30 patients with successful reduction were performed laparoscopic appendectomy.3 cases of laparoscopic reduction were failed because of intestinal necrosis or extremely tight intussusception.3 cases were converted to laparoscopic-assisted intestinal resection and anastomosis because of Meckel diverticulum(n=2) and lymphoma(n=1).The mean operative time was 45 min,the mean operative time of laparoscopic appendectomy was 8 min,intestinal function recovered in 48 h after operation,and the mean hospital stay was 5 d.No recurrence and operative complications were found during the follow-up till now.Conclusions:Laparoscopic intussusception reduction combined with gaseous enema reduction and injection of physiological saline in intussuscipiens is safe,reliable and mini-invasive.Laparoscopic appendectomy following the reduction and no fixation of ileum can effectively prevent recurrence of intussusception.更多还原