Wei Chin-Hung, Fu Yu-Wei, Wang Nien-Lu, Du Yi-Cheng, Sheu Jin-Cherng
Division of Pediatric Surgery, Department of Surgery, Mackay Memorial Hospital, No.92, Section 2, Zhongshan N. Rd., Zhongshan Dist, Taipei City, 10449, Taiwan,
Surg Endosc. 2015 Mar;29(3):668-72. doi: 10.1007/s00464-014-3717-1. Epub 2014 Jul 19.
This study aims to compare the results of laparoscopy and open surgery for idiopathic intussusception in children as well as evaluate the efficacy of ileopexy.
Between January 2007 and July 2013, children aged <18 years who were operated for intussusception in our institution were reviewed. Patients were classified into two groups, laparoscopy (LAP) and open (OPEN). Both groups were further divided into two subgroups, ileopexy (IP) and non-ileopexy (NIP). Parameters investigated included age, gender, operative indication, surgical procedure, type of intussusception, level of intussusceptum, presence of spontaneously reduced intussusception and pathologic lead points, operative time (OP time), time to oral intake (PO time), length of postoperative hospital stay (LOS), and surgical recurrence.
There were 23 and 35 patients in LAP and OPEN group, respectively. No significant difference was found on age, operative indication, surgical procedure, type of intussusception, level of intussusceptum, and presence of spontaneously reduced intussusception between both groups. In LAP group, mean OP time was significantly longer; mean PO time and LOS were significantly shorter. One surgical recurrence occurred in each group (p = 0.76). In comparison of LAP-IP (n = 15) and LAP-NIP (n = 8), OP time, PO time, and LOS were similar in both subgroups. One recurrence was noted in LAP-IP (p = 0.46). The overall conversion rate was 13.0 % (6.8 vs. 25 %, p = 0.21). Compared to patients with intussusceptum to ascending colon, the conversion rate was significantly higher in patients with intussusceptum to transverse and descending colon. With the exclusion of conversion, OP time was significantly shorter in LAP-NIP (p = 0.01).
Laparoscopy should be considered the primary modality for radiologically irreducible or recurrent idiopathic intussusception in children. Ileopexy provides no benefit on recurrence prevention but contributes to longer OP time.
本研究旨在比较腹腔镜手术与开放手术治疗儿童特发性肠套叠的效果，并评估回肠固定术的疗效。
回顾2007年1月至2013年7月在我院接受肠套叠手术的18岁以下儿童。患者分为两组，腹腔镜手术组（LAP）和开放手术组（OPEN）。两组再进一步分为两个亚组，回肠固定术组（IP）和非回肠固定术组（NIP）。研究参数包括年龄、性别、手术指征、手术方式、肠套叠类型、套入部水平、自发性复位肠套叠及病理性引导点的存在情况、手术时间（OP时间）、经口进食时间（PO时间）、术后住院时间（LOS）及手术复发情况。
LAP组和OPEN组分别有23例和35例患者。两组在年龄、手术指征、手术方式、肠套叠类型、套入部水平及自发性复位肠套叠的存在情况方面均无显著差异。LAP组的平均OP时间显著更长；平均PO时间和LOS显著更短。每组均发生1例手术复发（p = 0.76）。比较LAP-IP组（n = 15）和LAP-NIP组（n = 8），两个亚组的OP时间、PO时间和LOS相似。LAP-IP组有1例复发（p = 0.46）。总体中转率为13.0%（6.8%对25%，p = 0.21）。与套入部至升结肠的患者相比，套入部至横结肠和降结肠的患者中转率显著更高。排除中转情况后，LAP-NIP组的OP时间显著更短（p = 0.01）。
对于儿童放射学上不可复位或复发性特发性肠套叠，腹腔镜手术应被视为主要治疗方式。回肠固定术对预防复发无益处，但会导致手术时间延长。
