腹腔镜诊治新生儿先天性十二指肠梗阻54例  

Laparoscopic Diagnosis and Treatment of Congenital Duodenal Obstruction in 54 Newborns

作　　者：王莹[1] 马丽霜[1] 张艳霞[1] 冯翠竹[1] 刘超 魏延栋[1] 李景娜[1] Wang Ying;Ma Lishuang;Zhang Yanxia(Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing 100020, China)

机构地区：[1]首都儿科研究所附属儿童医院普通新生儿外科,北京100020

出　　处：《中国微创外科杂志》2021年第6期495-499,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：国家重点研发计划基金(2018YFC1002503);北京市卫生与健康科技成果和适宜技术推广项目基金(BHTPP202005);北京市儿科学科协同发展中心儿科专项基金(XTZD20180305,XTGL201912)。

摘　　要：目的总结腹腔镜诊治新生儿十二指肠梗阻的经验。方法回顾性分析2015年10月~2019年5月54例新生儿先天性十二指肠梗阻资料。年龄1~26 d,中位数1 d;出生体重1155~4400 g,平均2771.9 g。术前诊断十二指肠梗阻,其中肠旋转不良合并肠扭转12例,环状胰腺28例,十二指肠膜式闭锁14例。结果腹腔镜探查结果除确定上述病因外,肠旋转不良12例中合并空肠闭锁2例;环状胰腺28例中合并肠旋转不良2例,异位胰腺1例,同时合并肠旋转不良、空肠闭锁及异位胰腺多发畸形1例;十二指肠膜式闭锁14例中合并肠旋转不良3例。除2例肠扭转局限肠坏死中转开腹行肠切除吻合术外,其余52例均在腹腔镜下完成手术,无术中并发症。2例术后放弃治疗出院。其余52例术后初次经口喂养时间(5.3±1.2)d,完全经口喂养时间(12.5±4.2)d。1例肠旋转不良术后1个月因肠扭转再次行腹腔镜手术。余51例术后1个月复查超声,其中20例复查上消化道造影,均无消化道梗阻。52例随访3~36个月,平均12.5月,均生长发育良好。结论胃肠超声、消化道造影等可以初步判断新生儿先天性十二指肠梗阻的病因,腹腔镜手术可以探查有无多发肠道畸形并同时处理,对于低出生体重儿、早产儿同样安全适用。Objective To summarize the experience of laparoscopic surgery of congenital duodenal obstruction(CDO)in neonates.Methods Clinical data were reviewed on 54 CDO neonates who were diagnosed and laparoscopic treated from October 2015 to May 2019.The median age was 1 d old(range,1-26 d old)and the average weight was 2771.9 g(range,1155-4400 g).All the cases were diagnosed as congenital duodenal obstruction before surgery,including 12 cases of intestinal malrotation,28 cases of annular pancreas and 14 cases of duodenal diaphragm.Results The above etiological diagnosis was confirmed by laparoscopy.There were 12 cases of intestinal malrotation(2 cases were associated with jejunal atresia),28 cases of annular pancreas(2 cases were associated with intestinal malrotation,1 case was associated with heterotopic pancreas,and 1 case was associated with intestinal malrotation,jejunal atresia,heterotopic pancreas),and 14 cases of duodenal diaphragm(3 cases were associated with intestinal malrotation).There were 52 neonates receiving laparoscopic surgery successfully and 2 neonates converted to open surgery because of intestinal necrosis.Two patients gave up treatment and were discharged.Among the remaining 52 cases,the meantime of initial oral feeding was(5.3±1.2)d,and the postoperative adequate food intake was(12.5±4.2)d.One case of intestinal malrotation recurred and was given re-laparoscopic surgery.The remaining 51 cases were re-examined by ultrasonography one month after operation,and 20 cases were re-examined by upper gastrointestinal contrast examination,and no digestive tract obstruction was found.A total of 52 cases were followed up for 3-36 months(mean,12.5 months),all of whom grew and developed well.ConclusionsUltrasound and upper gastrointestinal contrast are useful to the classification of CDO in neonates.Laparoscopic surgery is safe for low birth weight and premature neonates,which can also find and treat multi-malformation.

关 键 词：新生儿 十二指肠梗阻 腹腔镜手术 

分 类 号：R73[医药卫生—肿瘤]