腹腔镜技术在不同出生体重新生儿十二指肠梗阻中的应用研究  

Application of laparoscopic technique for duodenal obstruction in neonates with different birth weights

作　　者：胡书奇 吕成杰[1] 韩一江 赵晓霞[1] 赖登明 马东 王鹏[1] 陈锐[1] 秦琪[1] 钭金法[1] 黄寿奖[1] Hu Shuqi;LüChengjie;Han Yijiang;Zhao Xiaoxia;Lai Dengming;Ma Dong;Wang Peng;Chen Rui;Qin Qi;Tou Jinfa;Huang Shoujiang(Department of Neonatal Surgery,Affiliated Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Children's Health,Hangzhou 310000,China)

机构地区：[1]浙江大学医学院附属儿童医院新生儿外科,国家儿童健康与疾病临床医学研究中心,浙江省杭州市310000

出　　处：《临床小儿外科杂志》2020年第9期800-805,共6页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金资助项目(编号:81901989);中国博士后科学基金资助项目(编号:2019M652108)。

摘　　要：目的分析不同出生体重十二指肠梗阻新生儿腹腔镜手术治疗过程中的临床资料,为腹腔镜手术治疗新生儿十二指肠梗阻的安全性和可行性提供参考依据。方法回顾性分析浙江大学医学院附属儿童医院新生儿外科2017年6月至2019年6月收治的42例因十二指肠梗阻接受腹腔镜手术治疗的新生儿病例资料,根据体重分为正常出生体重组、低出生体重组和极低出生体重组,监测手术相关指标以及CO2气腹前后的血气指标。结果低出生体重组16例(男4例,女12例),极低出生体重组6例(男4例,女2例),正常出生体重组20例(男10例,女10例)。三组术中出血量(F=0.1,P=0.905)、手术时间(F=0.636,P=0.535)、术后拔管时间(F=1.244,P=0.299)、术中体温(F=1.303,P=0.283)差异均无统计学意义;出血量/出生体重(F=5.681,P=0.007)、初次喂养到全量喂养时间(F=11.638,P<0.001)、术中体温波动(F=18.09,P<0.001)差异有统计学意义。血气分析结果显示,各组患儿CO2气腹建立前后血气中pH值、PaCO2、PaO2、SO2、HCO-3、SBE值均有变化。气腹建立后,患儿血气中pH值均降低,PaCO2均上升。结论腹腔镜技术在不同出生体重新生儿十二指肠梗阻中的应用是安全可行的,术中要尤其关注出血量,加强体温监测,关注CO2气腹对血气的影响并及时调整。Objective To provide more clinical rationales for the safety and feasibility of laparoscopy by comparing the corresponding data for neonatal duodenal obstruction with different birth weights.Methods A retrospective analysis was performed for 42 neonates undergoing laparoscopy for duodenal obstruction from June 2017 to June 2019.For normal birth weight,low birth weight and very low birth weight infant groups,blood gas profiles before and after pneumoperitoneum were monitored.And surgical related parameters(e.g.intraoperative changes of body temperature,fluctuation range of body temperature,bleeding volume,operative duration&postoperative tracheal intubation)were recorded.Results The clinical data were summarized for 42 neonates undergoing laparoscopy for duodenal obstruction.There were 16 cases(4 boys and 12 girls)of low birth weight,6 cases(4 boys and 2 girls)of very low birth weight and 20 cases(10 boys and 10 girls)of normal birth weight.Comparing three groups,intraoperative volume of blood loss(F=0.1,P=0.905),operative duration(F=0.636,P=0.535),extubation Time(F=1.244,P=0.299)or intraoperative temperature(F=1.303,P=0.283)had no statistically significant difference;bleeding volume or birth weight(F=5.681,P=0.007),time from initial feeding to full feeding(F=11.638,P<0.001)and intraoperative temperature fluctuations(F=18.09,P<0.001)were statistically significant.Blood gas analysis indicated that the values of pH,PaCO2,PaO2,SO2,HCO-3 and SBE all changed before and after establishing CO2 pneumoperitoneum.After pneumoperitoneum,pH value decreased,PaCO2 increased and the change trend remained consistent.Conclusion The application of laparoscopy is both safe and feasible for duodenal obstruction of newborns with different birth weights.During operation,surgeons should pay more attention to volume of blood loss,strengthen the monitoring of body temperature and monitor the change of blood gas during CO2 pneumoperitoneum.

关 键 词：十二指肠梗阻/外科学 腹腔镜检查 治疗结果 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科] R616.5[医药卫生—临床医学]