腹腔镜诊治新生儿先天性十二指肠梗阻  

Diagnosis and Treatment by Laparoscopy for Congenital Duodenal Obstruction in Newborn Infants

作　　者：耿娜[1] 李索林[1] 李英超[1] 时保军[1] 于增文[1] 马亚贞[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：《实用儿科临床杂志》2011年第11期833-835,共3页Journal of Applied Clinical Pediatrics

基　　金：国家"十一五"科技支撑项目(2006BAI05A00)

摘　　要：目的评价腹腔镜诊断和治疗新生儿先天性十二指肠梗阻（CDO）的可行性和疗效。方法回顾性分析2002年7月-2010年10月新生儿CDO患儿21例行腹腔镜手术的临床资料,腹腔镜下探查病因,并依据其病理类型予以相应手术矫治。结果 21例患儿均在腹腔镜下明确诊断,并顺利完成手术,肠旋转不良13例实施Ladd手术,十二指肠狭窄4例腔镜下纵行切开其前壁横行缝合,十二指肠闭锁2例和环状胰腺2例成功进行空肠十二指肠菱形吻合术。手术时间（73.0±21.3）m in（45~135 m in）,除1例术后发生暂时性吻合口漏,给予禁食水及肠外营养处理自愈外,无术中并发症出现。术后上消化道造影检查吻合口通畅,术后7~12 d痊愈出院。随访（31.3±4.8）个月,患儿生长发育正常。仅1例术后2个月出现肠黏连梗阻,予手术松解治愈。结论腹腔镜诊治新生儿CDO是一种安全有效的方法,具有创伤小、进食早、恢复快、美观等特点。但新生儿期腹腔镜手术对麻醉及围术期管理要求更高。Objective To evaluate the feasibility and availability of laparoscopy in diagnosis and treatment for newborn infants with congenital duodenal obstruction（CDO）.Methods Twenty-one neonates with CDO who underwent laparoscopic surgery were analyzed retrospectively from Jul.2002 to Oct.2010.Under the laparoscopic vision,the cause of CDO was explored and the CDO was treated proportionally according to corresponding pathological types.Results All procedures were successfully performed and the etiology was identified.A standard Ladd′s procedure was carried out in 13 newborns with intestinal malrotation.Four cases with duodenal diaphragmatic stenosis underwent a partial excision of the diaphragm after vertical incision of the anterior part in the duodenum followed by a transverse suture.A diamond-shaped side-to-side duodenal anastomosis was completed in 2 cases of duodenal atresia and 2 cases of annular pancreas.The average operative time was（73.0±21.3） min（45-135 min）.There were no intraoperative complications except for 1 case with transient anastomotic leak who was cured by draining for 3 days（from day 2 to 4 postoperatively） without another intervention.The patients were discharged from hospital on the seventh to twelfth postoperative day.One patient with symptom of ileus after laparoscopic surgery in 2 months was cured by the operation.All children were free with a normal growth and development during the median follow-up of（31.3±4.8） months.Conclusions Laparoscopic technique is a safe and excellent diagnostic and therapeutic method for CDO in newborns.It has advantages of minimally invasive approach,as manifested by a little trauma,an earlier oral intake,an earlier discharge from the hospital and a better appearance.There are higher demands for anaesthesia and the postoperation in the laparoscopic surgery of newborns.

关 键 词：腹腔镜 先天性十二指肠梗阻 Ladd′s手术 吻合术 缝合 婴儿 新生 

分 类 号：R726.5[医药卫生—儿科]