三孔法腹腔镜十二指肠菱形吻合术治疗61例新生儿先天性环状胰腺  

Three-port Laparoscopic Rhombic Duodenal Anastomosis in the Treatment of Congenital Annular Pancreas in 61 Neonates

作　　者：魏延栋[1] 王莹[1] 马立霜[1] 冯翠竹[1] 张艳霞[1] 刘超 吴涛[1] 李景娜[1] Wei Yandong;Wang Ying;Ma Lishuang(Department of Neonatal Surgery,Children’s Hospital Affiliated to 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新生儿外科,北京100020

出　　处：《中国微创外科杂志》2024年第6期422-426,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：北京市高层次公共卫生技术人才培养计划(学科骨干-01-034)。

摘　　要：目的探讨腹腔镜手术治疗新生儿先天性环状胰腺的安全性和可行性。方法2015年6月~2023年6月我们对61例新生儿先天性环状胰腺采用三孔法腹腔镜手术,腹腔镜下分别游离环状胰腺远近端十二指肠,将十二指肠悬吊,近端扩张十二指肠横行切开,远端狭窄部分纵行切开,5-0 PDS线连续缝合十二指肠前后壁。结果3例中转开腹手术,余58例腹腔镜下完成手术。手术时间60~324 min,(163±57)min。术后经口开始喂养时间3~15 d,(6.8±2.9)d。住院时间4~83 d,中位时间17 d。1例术后12 d因肠粘连梗阻,行腹腔镜下肠粘连松解。1例术后3 d出现吻合口漏,行腹腔镜下修补。1例伴有早产,低出生体重,术后73 d出现重症感染、休克、弥散性血管内凝血,家属放弃治疗后死亡;余60例均治愈出院。60例术后胰腺超声见胰腺形态可,胰管无扩张,胆管无扩张,无胰腺炎。60例随访时间1~96个月,中位数37个月,均生长发育良好。结论腹腔镜手术治疗新生儿先天性环状胰腺是安全、可行的,对于早产儿、低出生体重儿围术期需精细化管理。Objective To explore the safety and feasibility of laparoscopic surgery for congenital annular pancreas in neonates.Methods From June 2015 to June 2023,a total of 61 neonates with congenital annular pancreas were treated with threeport laparoscopic surgery.Under the laparoscope,the proximal and distal segments of the duodenum around the annular pancreas were freed.The duodenum was then suspended,and a transverse incision was made in the dilated proximal duodenum while a longitudinal incision was made in the narrowed distal part.Continuous suturing of the anterior and posterior walls of the duodenum was performed with 5-0 PDS sutures.Results Three cases were converted to open surgery,while the remaining 58 cases were completed under laparoscope.The duration of surgery ranged 60-324 min,with an average of(163±57)min.The time to start oral feeding after surgery ranged 3-15 d,with an average of(6.8±2.9)d.The length of hospital stay varied 4-83 d,with a median of 17 d.One case experienced intestinal adhesive obstruction at 12 d after surgery,and underwent laparoscopic adhesion release.One case developed anastomotic leakage at 3 d after surgery and underwent laparoscopic repair.One case with prematurity and low birth weight developed severe infection,shock,and disseminated intravascular coagulation at 73 d after surgery,and died after the family decided to discontinue treatment.The remaining 60 cases were discharged after successful treatment.All the 60 patients were regularly followed up for 1-96 months,with a median of 37 months,having a good growth and development.Conclusions Laparoscopic surgery in the treatment of congenital annular pancreas in neonates is safe and feasible.Refined management is required during the perioperative period for premature and low birth weight infants.

关 键 词：腹腔镜 新生儿 环状胰腺 

分 类 号：R726.5[医药卫生—儿科]