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目的探讨单孔腹腔镜辅助经脐“Z”形切口治疗小儿消化道出血的可行性。方法采用单孔腹腔镜辅助经脐孔“Z”形切口对25例消化道出血患儿进行治疗。于脐孔置入10 mm Trocar,进无损伤操作钳,探查找到憩室或重复畸形肠段后,延长脐部切口成“Z”形,将病变肠管提出腹腔外行肠切除肠吻合术。1例术中发现并右侧腹股沟隐性斜疝,行疝囊高位结扎。结果 25例手术获得成功,无中转开腹手术。手术时间65～95 min,平均78 min。术后病理检查证实为梅克尔憩室22例,小肠重复畸形3例,18例有胃黏膜异位。术后4 d进流质饮食,5～8 d出院。无脐疝、肠瘘及肠梗阻等并发症发生。结论单孔腹腔镜辅助经脐“Z”形切口治疗因梅克尔憩室或肠重复畸形引起的消化道出血安全可行,具有创伤小、切口隐蔽、外形美观等优点。
Objective To investigate the feasibility of single-hole laparoscopic assisted transurethral “Z” shaped incision in the treatment of children with gastrointestinal bleeding. Methods 25 cases of children with gastrointestinal bleeding were treated with single hole laparoscopy assisted with “U” shape incision. Put 10 mm Trocar into the umbilicus, into the non-invasive operation forceps, explore the diverticulum or repeated deformity intestinal segment, extend the umbilical incision into a “Z” shape, the bowel of the bowel lesions were submitted for intestinal resection intestinal anastomosis. One case of intraoperative findings and the right inguinal hernia, hernia sac high ligation. Results 25 cases of successful surgery, no transit laparotomy. The operation time was 65-95 minutes with an average of 78 minutes. Postoperative pathology confirmed Meckel’s diverticulum in 22 cases, 3 cases of small intestine deformity, 18 cases of gastric mucosal ectopic. After 4 days into the liquid diet, 5 to 8 d discharged. Umbilical hernia, intestinal fistula and intestinal obstruction and other complications occurred. Conclusions The single hole laparoscope assisted by “U” / “Z” shaped incision is safe and feasible for gastrointestinal bleeding caused by Meckel ’s diverticula or intestinal deformity. It has the advantages of small trauma, concealed incision and beautiful appearance.