腹腔镜下肠旋转不良的诊断与治疗  

Laparoscopic diagnosis and treatment for intestinal malrotation in children

作　　者：李索林[1] 李英超[1] 于增文[1] 王志超[1] 

机构地区：[1]河北医科大学第二医院小儿外科,石家庄050000

出　　处：《中华小儿外科杂志》2008年第10期577-579,共3页Chinese Journal of Pediatric Surgery

基　　金：基金项目：国家十一五科技支撑项目（编号：2006BAI05A00）

摘　　要：目的评价腹腔镜对肠旋转不良的诊断与治疗效果并探讨纠正中肠扭转的适合条件。方法2002年7月至2008年3月对23例临床拟诊的肠旋转不良进行腹腔镜手术。男13例，女10例。年龄5d-12岁，平均1．9岁。采用三孔技术，腹腔镜确诊后，牵拉肠管纠正中肠扭转复位，切断Ladd索带、游离卜二指肠及空肠起始部，发现合并畸形同时处理。结果23例均在腹腔镜下确定诊断并顺利完成Ladd手术，18例并发中肠扭转270°～960°，予以复位；其中2例合并十二指肠旁疝、1例十二指肠隔膜、1例空肠异位胰腺和1例梅克尔憩室同时完成手术。手术时间35～150min，平均（65．2±15．8）min。术后1～3d进食，没有手术并发症。1例术后2个月因近端空肠粘连再次手术。21例获得随诊1个月～5年，生长发育良好。结论腹腔镜可明确诊治肠旋转不良，可以在新生儿期安全实施，适用于并发亚急性中肠扭转的患儿，具有创伤小、进食早、恢复快和美容效果好的优点。Objective To evaluate the effectiveness of a laparoscopic approach for the diagnosis and surgical treatment of intestinal malrotation, and to explore the optimal repairing conditions for midgut volvulus. Methods From July 2002 to March 2008, twenty three children with suspected intestinal malrotation underwent the diagnostic laparoscopy. There were 13 males and 10 females. The age of patients ranged from 5 days to 12 years, with the average of 1.9 years. The laparoscopic procedure was performed with 3 trocars to make a diagnosis. Under laparoscopic vision, the reposition of malrotated intestine was done by manual grasping and pulling, Ladd＇s band was incised, the duodenum and proximal jejunum were mobilized, and the concomitant abnormities were treated at the same time. Results Twenty-three cases suffered from intestinal malrotation were managed by Ladd＇s operation under laparoscope. Eighteen cases with midgut volvulous from 270 to 960 degree were corrected successfully, among whom, two cases were found with paraduodenal hernia, 1 with duodenal web, 1 with ectopic pancreas and 1 with Meckel＇s diverticulum. All of the incidental findings above had surgical treatment meanwhile with the Ladd＇s operation. The average operative time was 65.2±15.8 min （ranging from 35 to 150 mins）. Feedings were started on 1 to 3 days postoperatively with no complications. But one case underwent the second operation for proximal jejunal adhension 2 months later after operation. Twenty-one patients had been followed up from 1 month to 5 years, all of whom got satisfactory growth and development. Conclusions The intestinal malrotation can be diagnosed and treated with laparoscopy which can be performed in neonates securely and applied for a subacute midgut volvulus. Patients also benefit from this minimally invasive approach with earlier oral intake, shorter period of hospitalization and more aesthetic scar on skin.

关 键 词：腹腔镜 肠疾病 临床分析 治疗方法 

分 类 号：R686[医药卫生—骨科学]