腹腔镜下十二指肠简化斜形侧侧吻合术治疗新生儿十二指肠梗阻疗效观察  

Effect of laparoscopic simple oblique duodenoduodenostomy in the treatment of congenital duodenal obstruction in neonates

作　　者：李炳 陈为兵 夏顺林 张丰年 胡晓婷 杜永春 王晓敏 Li Bing;Chen Weibing;Xia Shunlin;Zhang Fengnian;Hu Xiaoting;Du Yongchun;Wang Xiaomin(Department of Pediatric Surgery,Huaian Women and Children′s Hospital,Huaian,Jiangsu 223002,China)

机构地区：[1]淮安市妇女儿童医院小儿外科,江苏省223002

出　　处：《中国基层医药》2020年第22期2698-2702,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：江苏省妇幼健康科研项目(F201713);江苏省淮安市科技计划项目(HAS201615)。

摘　　要：目的探讨腹腔镜下十二指肠简化斜形侧侧吻合术治疗新生儿先天性十二指肠梗阻的可行性。方法回顾分析淮安市妇女儿童医院2015年2月至2018年2月以腹腔镜下十二指肠简化斜形侧侧吻合术治疗的新生儿十二指肠梗阻15例的临床资料。术中腹腔镜探查腹腔,采用5~8 mmHg低压气腹及肝脏悬吊技术,并利用四孔法进行腹腔镜手术:5 mm经脐部trocar放置腹腔镜,另外三个3 mm trocar放置微型操作器械。腹腔镜下游离十二指肠,明确诊断后,远端十二指肠距离梗阻点0.5~1 cm处纵向切开,近端十二指肠距离梗阻处0.5 cm斜形切开,并用5-0 PDS线完成腹腔镜十二指肠"简化""斜形"侧侧吻合术。结果该组15例,平均年龄2(1~3)d。腹腔镜探查确定十二指肠闭锁4例(Ⅲ型),环状胰腺11例,其中环状胰腺合并先天性肠旋转不良7例。患儿都采用腹腔镜下十二指肠简化斜形侧侧吻合术进行治疗,其中7例同时在腹腔镜下行Ladd手术。腹腔镜手术时间:均值为115.0 min,标准差25.5 min,区间为70~145 min。术中出血少,无术中输血者,无手术相关的特殊并发症。术后4~10 d(平均6.0 d)进流质饮食,无腹胀呕吐,7~14 d(平均10.6 d)出院,该组无手术死亡,无中转开腹,无术中、术后并发症。患儿获得随访2~36个月(平均15.6个月),生长发育良好,无特殊并发症。结论腹腔镜下十二指肠斜形侧侧吻合术治疗先天性十二指肠闭锁和先天性环状胰腺具有手术操作容易、肠功能恢复快等特点,可以在新生儿期安全实施。Objective To explore the possibility of laparoscopic simple oblique duodenoduodenostomy in the management of congenital duodenal obstruction in neonates.Methods The clinical data of neonates with congenital duodenal obstruction undergoing laparoscopic simple oblique duodenoduodenostomy at Huaian Women and Children′s Hospital from February 2015 to February 2018 were retrospectively reviewed.By a lower-pressure pneumoperitoneum of 5-8mmHg and a suspending suture for right liver elevator,the procedure was performed using 4 ports:a transumbilical 5-mm port for the camera and another three 3-mm ports for instruments.After kocherizing of the proximal and distant part of the duodenum,the lower duodenum was incised longitudinally 0.5-1cm distal to the blocked end,the upper duodenum incision was placed 0.5cm away from the blocked end extended downward obliquely.The duodenoduodenostomy was performed as a"simple""oblique"anastomosis with 5-0 PDS suture.Results Fifteen patients were identified with a median age at operation of 2 days.Of all the cases,4 cases were duodenal atresia(typeⅢ),11 cases were annular pancreas,and 7 cases of them were annular pancreas complicated with congenital intestinal malrotation.All cases were treated with laparoscopic simple oblique duodenoduodenostomy.Ladd procedure was accomplished in 7 cases with congenital intestinal malrotation in the meantime.The average operative time was(115.0±25.5)min(70-145 min).Feedings were started on postoperative 4-10d(mean 6.0d),without abdominal distention and vomit,all patients were discharged in good health with a median postoperative hospital stay of 7-14d(mean 10.6d).There was no mortality rate,no conversion to laparotomy,and no intraopertive complications in the group.The cases were followed-up for 2-36 months(mean 15.6 months),and all cases were doing well.Conclusion Laparoscopic simple oblique duodenoduodenostomy is safe and efficacious in neonatal period,and can be a viable option in the treatment of neonates with congenital duodenal obstruction.

关 键 词：十二指肠梗阻 先天性 腹腔镜 侧侧吻合 新生儿 

分 类 号：R726.5[医药卫生—儿科]