CAJ | 학술논문

目的探讨腹腔镜Ladd手术治疗婴幼儿先天性肠旋转不良的可行性及手术效果.方法回顾性分析2011年1月至2013年12月湖北省武汉市妇女儿童医疗保健中心收治的50例先天性肠旋转不良患儿的临床资料,其中27例患儿行开腹Ladd手术设为开腹组,23例患儿行腹腔镜Ladd手术设为腹腔镜组.观察两组患儿手术时间、术后肛门排气时间、住院时间、术后是否发生切口感染及肠梗阻等情况.采用门诊或电话方式进行随访,随访时间截至2014年3月.正态分布的计量资料以x-±s表示,采用t检验;计数资料采用x2检验或Fisher确切概率法.结果开腹组患儿手术时间、术后肛门排气时间、住院时间分别为(69±7)min、(41±9)h、(10.4 ±2.4)d;腹腔镜组分别为(92±13) min、(28 ±5)h、(6.4±1.5)d,两组比较,差异均有统计学意义(t=6.21,16.50,6.34,P＜0.05).开腹组术后2例患儿切口感染,1例患儿术后肠梗阻;腹腔镜组未见切口感染及术后粘连性肠梗阻发生.全组患儿术后随访6个月至2年,平均随访13个月,患儿生长发育良好,症状消失.结论腹腔镜Ladd手术是一种安全、有效的技术,较之开腹Ladd手术具有明显的优势,可以作为治疗婴幼儿先天性肠旋转不良优先选择的手术方式.
목적 탐토복강경Ladd수술치료영유인선천성장선전불량적가행성급수술효과.방법 회고성분석2011년1월지2013년12월호북성무한시부녀인동의료보건중심수치적50례선천성장선전불량환인적림상자료,기중27례환인행개복Ladd수술설위개복조,23례환인행복강경Ladd수술설위복강경조.관찰량조환인수술시간、술후항문배기시간、주원시간、술후시부발생절구감염급장경조등정황.채용문진혹전화방식진행수방,수방시간절지2014년3월.정태분포적계량자료이x-±s표시,채용t검험;계수자료채용x2검험혹Fisher학절개솔법.결과 개복조환인수술시간、술후항문배기시간、주원시간분별위(69±7)min、(41±9)h、(10.4 ±2.4)d;복강경조분별위(92±13) min、(28 ±5)h、(6.4±1.5)d,량조비교,차이균유통계학의의(t=6.21,16.50,6.34,P＜0.05).개복조술후2례환인절구감염,1례환인술후장경조;복강경조미견절구감염급술후점련성장경조발생.전조환인술후수방6개월지2년,평균수방13개월,환인생장발육량호,증상소실.결론 복강경Ladd수술시일충안전、유효적기술,교지개복Ladd수술구유명현적우세,가이작위치료영유인선천성장선전불량우선선택적수술방식.
Objective To explore the feasibility and effect of laparoscopic Ladd's surgery for the treatment of intestinal malrotation in infants.Methods The clinical data of 50 infants with intestinal malrotation who were admitted to the Wuhan Medical & Health Center for Women and Children from January 2011 to December 2013 were retrospectively analyzed.Of 50 infants, 27 infants receiving the open Ladd's surgery were allocated into the open surgery group and 23 infants receiving the laparoscopic Ladd's surgery were allocated into the laparoscopy group.The operation time, time to anal exsufflation, duration of hospital stay, postoperative incision infection and intestinal obstruction in the 2 groups were observed.All the patients were followed up by outpatient examination or telephone interview till March 2014.The measurement data with normal distribution were presented as x-± s and analyzed by the t test, and count data were analyzed using the chi-square test or Fisher exact probability.Results The operation time, time to anal exsufflation and duration of hospital stay were (69 ± 7)minutes, (41 ±9)hours and (10.4 ± 2.4)days in the open surgery group, which was significantly different from (92 ± 13)minutes, (28 ±5)hours and (6.4 ± 1.5) days in the laparoscopy group (t =6.21, 16.50, 6.34,P ＜ 0.05).Two infants had incision infection and 1 infant had intestinal obstruction in the open surgery group.There was no patient with complications in the laparoscopy group.All the patients were followed up for the median time of 13 months (range, 6-24 months), with a good survival and no other symptoms.Conclusion Laparoscopic Ladd's surgery is safe and feasible compared with open surgery, and it could be used as a prior operation method for treatment of intestinal malrotation in infants.