腹腔镜辅助治疗小儿先天性小肠闭锁和狭窄  

Laparoscope-assisted diagnosis and treatment for small intestinal atresia and stenosis in children- a report of 12 eases

作　　者：李炳 陈为兵 王寿青 张丰年 刘娟 杜永春 刘树立[2] 李龙 

机构地区：[1]江苏省淮安市妇女儿童医院小儿外科,223002 [2]首都儿科研究所外科

出　　处：《中华小儿外科杂志》2010年第7期498-501,共4页Chinese Journal of Pediatric Surgery

基　　金：国家十一五科技支撑计划课题（编号：2006BA105A06）

摘　　要：目的通过腹腔镜辅助诊治小儿先天性肠闭锁和狭窄，探讨腹腔镜技术在诊治小儿先天性肠梗阻性疾病的应用价值。方法2009年9月至2010年2月共收治了小儿小肠闭锁和狭窄患儿12例，其中1例空肠狭窄和2例Ⅰ型十二指肠闭锁的患儿腹胀不明显，选择在腹腔内进行隔膜切除及肠吻合术；3例Ⅱ型闭锁（25％）和6例Ⅲ型闭锁（50％）的患儿肠管扩张明显，用腹腔镜确定闭锁的部位和类型，然后将闭锁段小肠经脐窝提出至腹腔外行端斜吻合术。结果12例手术均在腹腔镜辅助下顺利完成。1例空肠狭窄和2例十二指肠闭锁的手术时间为80～100min，平均92min；Ⅱ型及Ⅲ型闭锁共9例，手术时间为40-65min，平均48min。经脐窝提出肠管时选脐部正中纵切口长约t．5～2cm。1例早产儿放弃治疗，其余患儿术后恢复良好，术后3～7d进流质饮食，无腹胀呕吐，9～16d出院，本组无手术死亡患儿。11例获得随访1～6个月，生长发育良好，无特殊并发症。结论对于小儿先天性肠梗阻性疾病，腹腔镜诊治具有切口小、创伤轻、恢复快等特点，优于传统开腹手术。Objective To retrospectively analyze the laparoscope-assisted diagnosis and treatment for small intestinal atresia and stenosis in children. Methods Between September 2009 and February 2010, 12 infants with small intestinal atresia and stenosis underwent laparoscope-assisted surgery at this center. Among the patients,Ⅰ was diagnosed as jejunum stenosis, 2 as type I duodenum atresia, 3 as typeⅡ atresia （25%）, and 6 as type Ⅲ atresia （50%）. No evident dilated abdomen was noted On the patients with jejunum stenosis or type Ⅰ duodenum atresia, and the laparoscopic operations were performed to remove the septum and restore intestinal continuity. On the patients with type Ⅱ and Ⅲ atresia, the bowel dilated evidently, laparoscopic inspection was performed to identify the location and the type of the malformations, and then the proximal and distal ends of the atresia were exteriorized through the umbilical port site for end to oblique anastomosis. Results The operative time for jejunum stenosis and type Ⅰ duodenum atresia ranged from 80 to 100 minutes （average, 92 mi nutes）. The operative time for type Ⅱ and typeⅢ atresia ranged from 40 to 65 minutes （average 48 minutes） . The incision of umbilical port was 1.5-2cm long. One premature infant was abandoned by the parents, all the other cases recovered from surgery. Feeding started between postoperative day 3 and 7. No dilated abdomen and vomit was noted. The patients were discharged from hospital between postoperative day 9 and 16. No patients died after surgery. Eleven patients were followed up for 1-6 months, no severe complications was noted. Conclusions Laparoscope-assisted surgery is minimally invasive and produces good outcomes in the diagnosis and treatment for congenital intestinal obstruction.

关 键 词：腹腔镜外科手术 肠闭锁 吻合术 外科 

分 类 号：R726[医药卫生—儿科]