CAJ | 학술논문

目的探讨小儿腹腔镜肠粘连松解术治疗小儿小肠粘连性肠梗阻的效果和经验.方法回顾分析2008年1月～2013年1月我院腹腔镜肠粘连松解术治疗腹部一次手术后粘连性肠梗阻47例患儿的临床资料.男25例,女22例.年龄7个月～12岁,平均(6.04±2.40)岁.距前次手术时间6个月～7年,平均(19.30±9.39)个月.结果全部病例均顺利完成手术,无中转开腹,无切口疝、伤口感染和肺炎等并发症.术中发现粘连肠管位于右上腹7例,右下腹31例,左上腹3例,位于左下腹6例；由于1条索带所致肠梗阻5例,≥2条索带22例,与腹壁粘连所致肠梗阻8例,肠管广泛致密粘连成团12例.12例肠管广泛致密粘连成团患儿,2例分别于术后第7天、第15天再次出现肠梗阻,经开腹手术予以切除粘连成团小肠、肠吻合术后痊愈,另2例术中分离粘连时小肠破裂,经镜下缝合修补.与腹壁粘连所致肠梗阻组和肠管广泛致密粘连成团组相比,索带所致肠梗阻组手术时间较短(P＜0.05).所有患儿均痊愈出院,术后随访3～60个月,均无粘连性肠梗阻、顽固性腹痛复发和营养不良发生.结论腹腔镜肠粘连松解术治疗小儿小肠粘连性肠梗阻是安全、可行和有效的；对肠管广泛致密粘连成团患儿,应严格把握手术适应证.
목적 탐토소인복강경장점련송해술치료소인소장점련성장경조적효과화경험.방법 회고분석2008년1월～2013년1월아원복강경장점련송해술치료복부일차수술후점련성장경조47례환인적림상자료.남25례,녀22례.년령7개월～12세,평균(6.04±2.40)세.거전차수술시간6개월～7년,평균(19.30±9.39)개월.결과 전부병례균순리완성수술,무중전개복,무절구산、상구감염화폐염등병발증.술중발현점련장관위우우상복7례,우하복31례,좌상복3례,위우좌하복6례；유우1조색대소치장경조5례,≥2조색대22례,여복벽점련소치장경조8례,장관엄범치밀점련성단12례.12례장관엄범치밀점련성단환인,2례분별우술후제7천、제15천재차출현장경조,경개복수술여이절제점련성단소장、장문합술후전유,령2례술중분리점련시소장파렬,경경하봉합수보.여복벽점련소치장경조조화장관엄범치밀점련성단조상비,색대소치장경조조수술시간교단(P＜0.05).소유환인균전유출원,술후수방3～60개월,균무점련성장경조、완고성복통복발화영양불량발생.결론 복강경장점련송해술치료소인소장점련성장경조시안전、가행화유효적；대장관엄범치밀점련성단환인,응엄격파악수술괄응증.
Objective To evaluate the outcomes of the laparoscopic adhesiolysis to small bowel obstruction (SBO) in children.Methods Clinical data of 47 cases of laparoscopic adhesiolysis to adhesion SBO from January 2008 to January 2013 were retrospectively analyzed.All of them experienced only once surgery history.Results All laparoscopic surgery were successfully completed without laparotomic conversions,there were no incisional hernia,wound infection and pneumonia complications.Adhesions located in the right upper quadrant of 7 cases,the right lower quadrant of 31 cases,the left upper quadrant of 3 cases and the left lower quadrant of 6 cases.The cause of obstruction was a single band (n =5),more than 2 bands (n =22),anterior abdominal wall adhesions (n =8) and extensive dense adhesions(n =12).Two patients with intestinal extensive dense adhesions were appeared SBO again,they were cured by laparotomy of intestinal resection and anastomosis.Small intestine was ruptured in another 2 cases,they were cured by endoscopic suture.The operative time for the bands caused SBO groups was shorter than that for the anterior abdominal wall adhesions or extensive dense adhesions caused SBO groups(P＜0.05).All patients were cured after surgery,and no adhesion SBO,intractable recurrent abdominal pain or malnutrition was found during postoperative follow-up (3-60m).Conclusions Laparoscopic adhesiolysis is safe,feasible and effective to treat adhesion SBO in children.For children with extensive dense intestinal adhesions,the indication for laparoscopic adhesiolysis should be more strictly controlled.