经脐旁单切口腹腔镜辅助肠外置治疗新生儿先天性小肠闭锁  

Transumbilical Single-incision Laparoscopic Assisted Surgery for Neonatal Congenital Intestinal Atresia

作　　者：位永娟 陈伟明 洪艺楠 Wei Yongjuan;Chen Weiming;Hong Yinan(Department of Neonatal Surgery,Quanzhou Maternal and Children’s Hospital,Quanzhou 362000,China)

机构地区：[1]泉州市妇幼保健院儿童医院新生儿外科,泉州362000

出　　处：《中国微创外科杂志》2023年第12期908-912,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨经脐旁单切口腹腔镜辅助肠外置治疗新生儿先天性小肠闭锁手术的效果。方法2019年9月~2022年9月我科对27例新生儿先天性小肠闭锁施行经脐旁单切口腹腔镜辅助手术。脐旁右侧弧形切口至1/2周径,置入3.5 cm一次性单孔多通道腹腔镜穿刺器(Port),直视下找到闭锁部位,切除近端肥厚肠管,远端肠管对系膜侧修剪切开,5-0可吸收缝线间断单层缝合,行端斜吻合术,然后建立CO_(2)气腹,观察整个腹腔情况,处理合并畸形。结果27例顺利完成手术,无中转开腹。术中证实空肠闭锁15例,回肠闭锁12例;闭锁类型Ⅰ型8例,Ⅱ型5例,Ⅲa型12例,Ⅲb型2例。术中见胎粪性腹膜炎5例,胆道闭锁1例,肠旋转不良2例,梅克尔憩室1例,隐睾2例,腹股沟斜疝1例。中位手术时间110.0(90.0,122.5)min。术后中位开始喂养时间11.0(7.0,14.5)d。无吻合口漏发生。术后中位住院时间18.0(15.0,33.5)d。1例患儿再次手术。22例随访0.5~4年(平均2.3年),无再次手术患儿。结论经脐旁单切口腹腔镜辅助肠外置治疗新生儿先天性小肠闭锁,切口无瘢痕,操作方便,结合Port使用,可以减少肠管卡压,方便牵引,腹腔镜可以同时处理合并畸形。Objective To discuss the efficacy of transumbilical single-incision laparoscopic surgery for neonatal congenital intestinal atresia.Methods A retrospective analysis was conducted on data of 27 children admitted to our hospital from September 2019 to September 2022 who underwent transumbilical single-incision laparoscopic assisted surgery.A curved incision on the right side of the umbilicus to 1/2 circumference was made.A 3.5 cm disposable single hole multi-channel port(Port)was inserted.The intestinal atresia was located under direct vision.The proximal hypertrophic intestinal tube was removed,and the distal intestinal tube to the mesenteric side was cut open.Intermittent single layer suture with 5-0 absorbable suture was performed for end-oblique incision anastomosis.Then the CO_(2) pneumoperitoneum was established,and the entire abdominal cavity was observed to deal with combined deformities.Results The surgery was successfully completed in all the 27 patients,without conversion to open surgery.During the surgery,15 cases of jejunal atresia and 12 cases of ileal atresia were confirmed.There were 8 cases of typeⅠ,5 cases of typeⅡ,12 cases of typeⅢa,and 2 cases of typeⅢb.During the surgery,there were 5 cases of meconium peritonitis,1 case of biliary atresia,2 cases of intestinal malrotation,1 case of Meckel’s diverticulum,2 cases of cryptorchidism,and 1 case of inguinal hernia.The median surgical time was 110.0(90.0,122.5)min.The median postoperative feeding time was 11.0(7.0,14.5)d.No anastomotic leakage occurred.The median postoperative hospital stay was 18.0(15.0,33.5)d.One child underwent the second surgery.A total of 22 cases were followed up for 0.5-4 years(average,2.3 years)without re-operations.Conclusions Transumbilical single-incision laparoscopic surgery for neonatal congenital intestinal atresia is scarless and easy to operate.Combined with the use of a Port,it can reduce intestinal compression and facilitate traction.Laparoscopy can simultaneously handle combined deformities.

关 键 词：经脐旁单切口 腹腔镜 先天性小肠闭锁 

分 类 号：R726.5[医药卫生—儿科]