悬吊牵引技术在小儿腹腔镜十二指肠吻合术中的应用

摘要

目的:观察十二指肠悬吊牵引技术在小儿腹腔镜十二指肠吻合术中的应用价值.方法:回顾性分析2013年5月-2015年5月在我院接受腹腔镜十二指肠吻合术的80例先天性肠闭锁和狭窄患儿的临床资料,根据术中是否使用十二指肠悬吊牵引技术分为对照组(未使用组)和观察组(使用组),每组各40例.所有患儿均采取腹腔镜三孔法.比较两组手术一般情况、术后并发症发生率及相关实验室指标.结果:观察组患儿的手术时间、初次进食时间、恢复正常饮食时间和住院时间均较对照组短,手术中转率及术中出血量明显少于对照组(P＜0.05);术前两组WBC、NEU％、PCT、IL-6、CPR等水平差异无统计学意义,术后第5天两组WBC、NEU％和IL-6水平均有所降低,但观察组下降更为明显(P＜0.05);观察组吻合口瘘、吻合口裂开、肠粘连、切口感染等术后并发症发生率明显较对照组低,差异有统计学意义(P＜0.05).结论:十二肠悬吊牵引技术应用于小儿腹腔镜十二指肠吻合术中,能够减少术中误伤,降低手术中转率,缩短手术时间,促进患儿术后恢复.%Objective:To observe the application value of duodenal suspension traction technology in laparoscopic duodenal anastomosis.Methods:80 cases of congenital intestinal atresia and stenosis A children treated in our hospital from May 2013 to May 2015were selected by retrospective study law,and were divided into the control group (not used) group and the observation group (with group) according to their surgery whether duodenum suspension traction technology,40 cases in each group.All patients were laparoscopic surgical approach for the three holes.The general surgery situation the incidence of postoperative complications and associated laboratory parameters in the two groups were compared.Results:The operative time,the initial feeding time,the time return to normal diet and hospital stay in observation group were shorter than those in the control group,and the number of blood loss and cases converted to open surgery in the procedure was as well as was significantly less than the control group (P＜0.05);Before surgery,the level of WBC,NEU％,and inflammatory cells factors as PCT,IL-6CPR in the two groups had no significant difference;five days after surgery,the level of WBC,NEU％ and IL-6 in the two groups were all decreased,but the observation group decreased more significantly(P＜0.05);observation group The rate of anastomotic leakage,anastomotic dehiscence,the incidence of adhesions,wound infection and other complications in observation group were significantly lower than the control group,the difference was statistically significance(P＜0.05).Conclusion:The duodenum suspension traction technology in laparoscopic duodenal anastomosis,can reduce accidental injury,then reduce the operation rate,thus shortening the duration of surgery in children,the time required for the first time to eat and hospitalization time for the expansion of the surgical field,and which significantly can reduce the incidence of postoperative infection and other complications in children.