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腹腔镜和开放手术方法治疗外科肠套叠:术后并发症的随机临床试验。

Laparoscopic and open surgery methods in managing surgical intussusceptions: A randomized clinical trial of postoperative complications.

机构信息

Pediatric Surgery Ward, Tabriz Medical Sciences' University, Tabriz, Iran.

General Surgery Ward, Tabriz Medical Sciences' University, Tabriz, Iran.

出版信息

Asian J Endosc Surg. 2022 Jan;15(1):56-62. doi: 10.1111/ases.12965. Epub 2021 Jul 12.

Abstract

PURPOSE

To compare postoperative complications of laparoscopic surgery (LS) with open surgery (OS) in surgical intussusception patients.

METHODS

From March 2015 to February 2018, infants between 6 to 24 months old had the clinical and sono-graphical signs of intussusception enrolled in this double-blind, randomized clinical trial. We divided surgical intussusception patients into two groups. In the LS group, we evaluated patients by direct laparoscopic observation, on-table hydrostatic enema, and mechanical reduction of intussusception. In the OS group, we performed the conventional technique. These patients were followed for 2 years after procedures for comparison of postoperative complications between the two groups.

RESULTS

We had 52 patients who needed surgical exploration (26 in each group). There were four (15%) and seven (27%) patients with self-reduced intussusception in LS and OS groups, respectively. The conversion rate was 31% (eight cases). Five cases (19%) in the LS group and four cases (15%) in the OS group needed bowel resections. Operating time was longer in the LS group (P ≤ 0.006), and the postoperative complication rate was higher in the OS group (P ≤ 0.021).

DISCUSSION

Laparoscopy is a screening tool to determine the need for OS in surgical intussusception patients. Laparoscopy reduces the incidence of OS and its complications.

摘要

目的

比较腹腔镜手术(LS)与开放手术(OS)治疗小儿肠套叠术后并发症。

方法

2015 年 3 月至 2018 年 2 月,对 6 至 24 个月大的具有肠套叠临床和超声征象的婴儿进行了这项双盲、随机临床试验。我们将肠套叠患者分为两组。在 LS 组中,我们通过直接腹腔镜观察、桌上水压灌肠和机械复位来评估患者。在 OS 组中,我们采用常规技术。两组患者均在手术后随访 2 年,比较两组术后并发症。

结果

我们有 52 名需要手术探查的患者(每组 26 名)。LS 组有 4 例(15%)和 OS 组有 7 例(27%)患者发生自行复位。转换率为 31%(8 例)。LS 组中有 5 例(19%)和 OS 组中有 4 例(15%)需要肠切除术。LS 组的手术时间较长(P≤0.006),OS 组的术后并发症发生率较高(P≤0.021)。

讨论

腹腔镜是确定小儿肠套叠患者是否需要 OS 的筛查工具。腹腔镜可以降低 OS 及其并发症的发生率。

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