完全腹腔镜下肠肠吻合技术在消化道畸形中的运用
Application of total laparoscopic enteroanastomosis for digestive tract malformations
目的 探讨完全腹腔镜下肠肠吻合技术在消化道畸形治疗中运用的可行性及安全性.方法 回顾性分析2015年1月至2015年12月完全腹腔镜下肠切除肠吻合治疗8例消化道畸形患儿的临床资料.其中,男6例,女2例;年龄1岁10个月~12岁8个月,平均5.4岁.患儿取仰卧位,气管插管.脐轮右上、左下分别置入3.5、5.0 mm Trocar.腹腔镜监视下,经病变于腹壁体表投影水平与左/右腹直肌外侧缘交界处置入5 mm Trocar.脐轮左上Trocar置入3mm目镜,另2个5mmTrocar置入操作器械.探查肠管,找到病变位置后,超声刀切除病变两端肠管,经腹壁进针(4-0带针丝线),浆肌层缝合两断端肠壁后牵引.5-0可吸收线连续全层缝合肠腔后壁(超过系膜侧肠壁),前壁连续浆肌层单层缝合.结果 本组8例均顺利完成完全腹腔镜下肠切除肠吻合.手术时间1.5~2.5h,平均1.9h.术中均未出血,术后6~12 h下床活动,疼痛均可耐受.术后未见切口感染、吻合口漏及粘连性肠梗阻发生.病理检查报告肠重复畸形5例,梅克尔憩室3例.结论 完全腹腔镜下肠肠吻合技术对于部分消化道畸形患儿是安全、有效的技术,但在病例选择上要严格把握指征.
更多Objective To assess the feasibility and safety of total laparoscopic enterectomy and enteroanastomosis for digestive tract malformations in children.Methods From January 2015 to December 2015,8 children with digestive tract malformations undergoing laparoscopy were retrospectively analyzed.There were 6 boys and 2 girls with an average age of 64.8 (22-132) months.Operative caveats:They were placed in a supine position with tracheal intubation anesthesia.A 3.5 mm Trocar was inserted into left upper of umbilical wheel and another 5.0 mm Trocar into right lower.A third 5-ram Trocar was placed in lateral border of left/right rectus abdominis at the projection level of abdominal lesion sudace under direct vision.And 3.0 mm laparoscope was introduced into 3.5 mm troear for laparoscopy and two other Trocars for manual instruments.Under laparoscope,the lesion was identified.Enterectomy was then performed intracorporeally with ultrasonic knife.Intestinal wall was sutured with 4-0 wire and suspension was applied.Posterior intestinal wall was continuous fullthickness sutured by 5-0 absorbable thread (beyond lateral mesangial intestinal wall) and anterior intestinal wall was continuously sutured through seromuscular layer.Results Laparoscopy was performed for all patients.The mean operative duration was 1.9 (1.5-2.5) hours.Postoperative course was uneventful.Pathological examinations confirmed the diagnoses of Meckel' s diverticulum (n =3) and enteric duplication cysts (n =5).Conclusions Total laparoscopic enterectomy and enteroanastomosis is safe,feasible and effective for children with digestive tract malformations.However,therapeutic indications and contraindications should be strictly defined.
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