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目的复发性肠套叠灌肠复位成功以后,早期应用腹腔镜技术行回盲部固定法,减少远期肠套叠复发及急诊剖腹手术的机会。探讨该技术的可行性及临床效果。方法 2014年2—11月,笔者对反复发作的肠套叠患儿,早期应用腹腔镜技术行回盲部固定法10例,其中男8例,女2例;年龄6~36个月,平均12.5个月。于脐部纵切口开放式置入5mm Trocar置入腹腔镜,然后分别于耻骨联合上方腹横纹处和左下腹置入2个3~5mm Trocar,放置操作器械进行探查,排除肠套叠的起源点,常规切除阑尾后,将升结肠起始部、阑尾根部和回肠末端用不可吸收的缝线分别固定于右侧腹壁。结果手术时间为45~85min,平均(59.4±13.11)min。无中转手术病例,术中出血极少。本组所有患儿术中未发现肠套叠起源点,无腹腔镜手术相关并发症。术后随访3~12个月,平均(7.2±3.12)个月,随访期间无肠套叠复发病例,无肠梗阻。结论对于反复发作的肠套叠患儿在灌肠复位成功后,早期应用腹腔镜进行干预,并行腹腔镜下回盲部固定法预防肠套叠复发,安全有效,可以发现相关畸形,排除肠套叠的起源点,并明确肠套叠是否完全复位,避免肠套叠复发及远期复发的相关并发症和急诊剖腹手术。
Objective After the success of recurrent intussusception enema reset, the early application of laparoscopic ileocecal fixation method to reduce the long-term recurrence of intussusception and emergency laparotomy opportunities. To explore the feasibility of the technology and clinical effects. Methods From February to November 2014, 10 children with intussusception were enrolled in this study. In the early stage, 10 cases of Ileocecal fixation were treated with laparoscopy, including 8 males and 2 females, aged 6 to 36 months, with an average of 12.5 months. In the umbilicus longitudinal incision open into the laparoscopic 5mm Trocar laparoscopic, and then respectively in the upper pubic symphysis pubic symphysis and left lower quadrant 2 3 ~ 5mm Trocar placed surgical instruments to explore the exclusion of the origin of intussusception Point, routine excision of the appendix, the ascending colon, the root of the appendix and the distal ileum with non-absorbable suture were fixed in the right abdominal wall. Results The operation time ranged from 45 to 85 minutes (mean, 59.4 ± 13.11) min. No cases of transit surgery, minimal intraoperative bleeding. All patients in our group found no origin of intussusception, no laparoscopic surgery-related complications. The patients were followed up for 3 to 12 months, with an average of (7.2 ± 3.12) months. No recurrence of intussusception was found during follow-up, and no intestinal obstruction was found. Conclusions For recurrent intussusception in children after the success of enema reduction, the early application of laparoscopic intervention and laparoscopic ileocecal fixation to prevent intussusception recurrence, safe and effective, you can find the associated deformity, excluding intussusception Of the origin point, and clear intussusception is completely reset, to avoid the recurrence of intussusception and long-term recurrence related complications and emergency laparotomy.