Xiao SJ,Yang WY,Zhu XC,et al. Analysis of laparoscopic diagnosis and treatment for 54 neonates with congenital duodenal obstruction.[J].Journal of Clinical Pediatric Surgery,2019,18(02):141-146.
腹腔镜治疗54例新生儿先天性十二指肠梗阻的疗效分析
- Title:
- Analysis of laparoscopic diagnosis and treatment for 54 neonates with congenital duodenal obstruction.
- Keywords:
- ; Duodenal Obstruction; Laparoscopes; Diagnosis; Therapy; Neonate
- 文献标志码:
- A
- 摘要:
- 目的总结新生儿先天性十二指肠梗阻病因诊断方法和腹腔镜微创手术治疗的经验。方法回顾性分析2017年1月至2018年3月由广东省妇幼保健院新生儿外科收治的54例新生儿先天性十二指肠梗阻的病例资料，通过产前超声、生后上消化道造影和胃十二指肠超声检查，作出术前病因诊断；采用三孔法进行腹腔镜探查，明确病因，排除十二指肠多处多病因梗阻，根据具体病因行腔镜下肠旋转不良矫正术（Ladds术）、十二指肠隔膜切除及纵切横缝术或十二指肠菱形吻合术。术中在腔镜直视和操作钳辅助下经鼻置入胃肠营养管至空肠，术后早期胃肠内营养。结果术前通过超声检查诊断为先天性肠旋转不良23例，十二指肠隔膜6例，十二指肠闭锁或狭窄10例，环状胰腺13例，十二指肠闭锁或狭窄合并十二指肠隔膜2例。腹腔镜探查确定上述病因，除2例十二指肠闭锁或狭窄还发现合并十二指肠隔膜外，其他诊断均与术前一致，诊断符合率为96.3%。所有病例在腹腔镜下完成手术，无一例中转开腹，无术中并发症。手术时间50~280 min,平均为（123.8±53.9） min。初次经口进食时间5~23 d，平均为（8.9±3.4）d，术后足量进食时间7~26 d，平均为（12.1±4.5）d，平均住院时间为（16.7±7.4）d。除3例先天性肠旋转不良术后出现肠扭转和肠粘连而再次手术外，无吻合口瘘、吻合口梗阻等术后并发症发生，无静脉营养相关并发症发生。术后随访，上消化道造影检查十二指肠无梗阻，喂养良好，无呕吐，伤口美观。结论新生儿先天性十二指肠梗阻可通过术前超声获得病因诊断，腹腔镜手术治疗可同时探查和处理多个梗阻，具有安全、创伤小、进食早、恢复快、美容效果好，疗效满意等优点。该术式可作为新生儿先天性十二指肠梗阻首选术式，对于低体重早产儿也是安全的。
- Abstract:
- ObjectiveTo summarize etiological diagnosis and laparoscopic surgery of congenital duodenal obstruction in neonates.MethodsRetrospective data analysis was performed for 54 neonates with congenital duodenal obstruction from January 2017 to March 2018.A preoperative etiological diagnosis was made by prenatal ultrasound,upper gastrointestinal angiography and gastroduodenal ultrasound examination.Then laparoscopic exploration were performed for excluding duodenal obstruction with multiple sites and causes.Laparoscopic Ladds procedure,duodenum diaphragm excision & transverse suture or duodenal diamond anastomosis were performed according to the specific pathogenesis.A gastrointestinal nutrition tube were placed via nose into jejunum with laparoscopic pliers for early feeding.ResultsPreoperative ultrasound indicated congenital intestinal malrotation (n=23),duodenal diaphragm (n=6),duodenal atresia/stenosis (n=10),annular pancreas (n=13) and duodenal atresia/stenosis accompanied with duodenal diaphragm (n=2).Except for 2 cases of duodenal atresia/stenosis plus duodenal diaphragm,the above etiological diagnosis was confirmed by laparoscopy.And the diagnostic accordance rate of preoperative etiology was 96.3%.All operations were completed with laparoscopy without any conversion into laparotomy or intraoperative complications.The mean operative duration was (123.8±53.9)(50-280) min.And the mean time of initial oral feeding,postoperative adequate food intake and hospitalization length was (8.9±3.4)(5-23),(12.1±4.5)(7-26) and (16.7±7.4)(8-57) days respectively.There was no onset of such postoperative complications as anastomotic fistula/obstruction or venous nutritionrelated complications.Except for 3 cases,intestinal torsion and intestinal adhesion occurred after surgery.Postoperative followups showed no duodenum obstruction and feeding was fine.There was no vomiting and wound healing was excellent.ConclusionPreoperative ultrasound may reach an etiological diagnosis of neonatal congenital duodenal obstruction.Laparoscope can detect and handle multiple duodenal obstructions at the same time.With the advantages of safety,minimal trauma,early food intake,quick recovery and excellent cosmetics effect,it is also ideal for lowweight and premature infants.
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