双镜联合技术在胃重复畸形诊疗中的应用  

Application of laparoscopy plus gastroscopy in the diagnosis and treatment of gastric duplication malformation

作　　者：罗艳梅 向旋 朱珍妮[3] 毛晓雯[2] 刘俊 杨星海[2] Luo Yanmei;Xiang Xuan;Zhu Zhenni;Mao Xiaowen;Liu Jun;Yang Xinghai;无(Health Science Center,Yangtze University,HuBei Province,Jingzhou 434023,China;Department of Surgical,Maternal and Child Health Hospital of Hubei Province,Wuhan 430070,China;Department of Gastroenterology,Maternal and Child Health Hospital of Hubei Province,Wuhan 430070,China)

机构地区：[1]长江大学医学部,荆州434023 [2]湖北省妇幼保健院外科,武汉430070 [3]湖北省妇幼保健院消化内科,武汉430070

出　　处：《中华小儿外科杂志》2022年第11期1030-1035,共6页Chinese Journal of Pediatric Surgery

基　　金：湖北省第二届医学领军人才工程培养对象暨湖北名医工作室(鄂卫通2019⁃47号)。

摘　　要：目的探讨经腹腔镜、胃镜双镜联合技术治疗胃重复畸形的适应性及可行性。方法收集2018年9月~2021年11月湖北省妇幼保健院外科收治的10例胃重复畸形手术治疗患儿临床资料,其中男8例,女2例;年龄范围为4 d~54个月;其中,合并其他系统畸形4例,多发型胃重复畸形1例(3个不同位置胃重复囊肿),剩下5例为单纯性胃重复畸形。对5例双镜联合手术的治疗效果、不同类型的胃重复畸形的手术时机、术式选择、术式难点、术后相关并发症、康复期及预后等因素进行分析。结果双镜联合下胃重复切除5例,平均手术时间为1 h,单纯胃重复畸形术后禁食时间约27 h,试行少量饮水或经胃管缓慢泵糖盐水后,24~48 h逐渐增加奶量,术后康复良好,治疗效果满意;单一腔镜手术并中转开腹2例,平均手术时间约2.5 h;直接开腹手术2例,平均手术时间约1.9 h;胃镜下黏膜去顶术1例。10例患儿分别随访6个月至3年,饮食正常,营养良好,无恶心、呕吐,胃部不适,腹部超声检查无复发,预后满意。结论胃镜辅助下腹腔镜下胃重复畸形剥除、切除术适用于浆肌层胃重复畸形,双镜联合下胃重复畸形切除术技术可行。Objective To explore the adaptability and feasibility of combined techniques of laparoscopy and gastroscopy for gastric duplication malformation.Methods Clinical data were retrospectively reviewed for 10 patients of gastric duplication malformation undergoing the combined techniques of laparoscopy and gastroscopy.There were 8 boys and 2 girls with an age range of 4 days to 54 months.The relevant factors such as operative timing,surgical approaches,handling difficulties,postoperative complications,rehabilitation period and prognosis were analyzed.Results Average operative duration was 1h and postoperative fasting time 27 h.After a gradual fluid intake via a gastric tube,milk was offered within 24⁃48 h and postoperative recovery was excellent.Two laparoscopic children were converted into laparotomy with an average operative duration of 2.5 h.Another two cases underwent open surgery with an average operative duration of 1.9 h.One child underwent endoscopic submucosal dissection.The follow⁃up period was from 6 months to 3 years.With a normal diet and a decent nutrition,there was no onset of nausea,vomiting or gastric discomfort.Abdominal ultrasonic examination revealed no recurrence.Conclusion Laparoscopy plus gastroscopy stripping and resection of gastric duplication is indicated for gastric duplication of serosa and muscular layer.And combined techniques of laparoscopy and gastroscopy are feasible.

关 键 词：胃重复畸形 胃镜 腹腔镜 

分 类 号：R726.5[医药卫生—儿科]