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目的总结双孔法腹腔镜手术在小儿不明原因下消化道出血诊治中的应用体会。方法小儿不明原因下消化道出血54例,采用双孔法腹腔镜行诊断与治疗。结果腹部超声组检查确诊率15.09%(8/53),腹部CT检查组确诊率11.54%(3/26),放射性核素组检查确诊率76.47%(39/51),腹腔镜探查组确诊率98.15%(53/54),53例发现小肠畸形,1例未发现异常。腹腔镜组探查确诊率高于其他3组。53例行腹腔镜手术均获得成功,无中转开腹手术;手术时间56~75分钟,平均67分钟,出血量3~10 ml。术后病理检查证实为美克尔憩室45例、小肠重复畸形7例、小肠血管畸形1例。结论双孔法腹腔镜手术用于小儿不明原因下消化道出血疾病具有诊断及治疗的双重价值,降低了腹腔镜手术的难度,适用于婴儿期甚至新生儿期患儿。
Objective To summarize the application of double-hole laparoscopic surgery in the diagnosis and treatment of gastrointestinal hemorrhage in children with unknown causes. Methods 54 cases of unknown cause of lower gastrointestinal bleeding in children, the use of double-hole laparoscopic diagnosis and treatment. Results The diagnosis rate of abdominal ultrasonography was 15.09% (8/53), that of abdominal CT was 11.54% (3/26), that of radionuclide was 76.47% (39/51), and that of laparoscopy 98.15% (53/54), 53 cases found intestinal malformations, 1 case found no abnormalities. Laparoscopy group confirmed the diagnosis rate was higher than the other three groups. 53 cases of laparoscopic surgery were successful, no transit laparotomy; operation time 56 to 75 minutes, an average of 67 minutes, the amount of bleeding 3 ~ 10 ml. Postoperative pathology confirmed that 45 cases of merkel diverticulum, small intestine deformity in 7 cases, 1 case of intestinal vascular malformations. Conclusions Double-hole laparoscopic surgery for the diagnosis and treatment of gastrointestinal bleeding in children with unknown causes has the dual value of diagnosis and treatment, reducing the difficulty of laparoscopic surgery, suitable for infants or neonates in children.