Abstract: 【Abstract】〓Objective〓To investigate the feasibility and surgical experience of laparoscopic reduction of pediatric intussusception with two trocars. Methods〓During June 2009 and June 2014, 32 cases of pediatric intussusception with either failing air enema reduction or recurrence of intussusception, underwent laparoscopic reduction of intussusception with two trocars. Of 32 cases, the patients who were successfully reduced by laparoscopic procedure were assigned to A group and those converted to open reduction served as B group. The clinical data were retrospectively analyzed and compared between two groups, including the age, onset time, type of intussusception, length of intussusception bowel, combined lesions. Results〓Twenty-four cases of intussusception were successfully reduced by laparoscopic reduction with two trocars (24/32, 75%), including 2 cases of Meckel’s diverticulum from 3 recurrent cases. Eight cases converted to open reduction by extending the umbilical incision, including 4 cases of ankylenteron caused by intestinal perforation or necrosis, 1 case of incarcerated ileum polypus, and 3 cases of long intussusception bowel. The patients of B group had longer intussusception bowel and higher rate of combined lesions than that of A group, and there were statistical differences between two groups. There were no significant difference between two groups in age and onset time and complications. Conclusion〓Laparoscopic reduction of intussusception with two trocars can be performed first for stable patients either failing air enema reduction or recurrence of intussusception. The length of intussusception bowel and combined lesions may be influence the success rate of laparoscopic reduction.

Key words: Child, Intussusception, Laparoscopy

摘要： 【摘要】 目的 探讨腹腔镜二孔法小儿肠套叠整复术的可行性及手术经验。方法〓2009年6月至2014年6月期间,32例空气灌肠复位失败或复位成功后复发的肠套叠患儿行腹腔镜二孔法肠套叠整复术,回顾患儿临床资料,对比二孔法复位成功和中转开腹复位两组患儿的年龄、起病时间、套叠类型、套头长度、合并病变等资料,分析影响腹腔镜下复位成功率的因素。结果〓32例患儿中24例应用腹腔镜二孔法肠套叠整复术复位成功,成功率75%,包括3例复发性肠套叠患儿。腹腔镜探查发现其中2例合并梅克尔憩室。其余8例需扩大脐部伤口中转开腹复位,中转手术原因包括:肠管穿孔或坏死后套叠肠管粘连4例、回肠息肉套头内嵌顿1例、套头过长3例。中转患儿的套头长度和合并病变占比明显长于腔镜复位组,其差异有统计学意义,而患儿年龄、起病时间及术后并发症两组间的差异无统计学意义。结论〓腹腔镜二孔法肠套叠整复术具有手术微创、成功率高的优点,掌握好适应症后可成为空气灌肠复位失败的非重症患儿和复发性肠套叠患儿优先选择的手术方法;套头长度和合并病变可能是影响二孔法复位成功率的因素。

关键词: 肠套叠, 儿童, 腹腔镜