Xiao Shangjie,Yang Wenyi,Xu Lu,et al.Mini-invasive surgery and early enteral nutrition after surgery in fast recovery of congenital duodenal obstruction in neonates[J].Journal of Clinical Pediatric Surgery,2019,18(04):272-276,298.[doi:10.3969/j.issn.1671-6353.2019.04.005]
微创手术与术后早期喂养在新生儿十二指肠梗阻加速康复中的应用
- Title:
- Mini-invasive surgery and early enteral nutrition after surgery in fast recovery of congenital duodenal obstruction in neonates
- Keywords:
- Duodenal Obstruction/SU; Enhanced Recovery After Surgery; Intraoperative Period; Stress; Infant Newborn
- 分类号:
- R493;R722.1;R656.6+4
- 摘要:
- 目的 总结新生儿十二指肠梗阻经腹腔镜微创手术与术后早期胃肠内营养的经验，分析其在新生儿十二指肠梗阻加速康复中的应用价值。方法 回顾性分析广东省妇幼保健院新生儿外科单个诊疗组于2017年1月至2018年10月收治的41例接受腹腔镜十二指肠吻合术的新生儿先天性十二指肠梗阻病例，根据术后开始胃肠内营养时间分为早期喂养组和常规喂养组。比较两组术后静脉营养持续时间、开始喂养时间、足量喂养时间、住院时间、住院费用、吻合口瘘及吻合口狭窄等并发症发生情况。结果 早期喂养组18例，常规喂养组23例，术前胎龄、体重、手术年龄、手术方式、手术时间两组间比较差异无统计学意义（P>0.05）。早期喂养组术后静脉营养持续时间平均为（6.6±1.29）d，常规喂养组为（11.96±4.33）d，差异有统计学差异（t=-5.608，P=0.001）；早期喂养组术后开始喂养时间和足量喂养时间分别为（1.17±0.38）d和（6.83±1.25）d，常规喂养组分别为（7.74±3.22）d和（12.61±4.36）d，差异均有统计学意义（P<0.05）。早期喂养组的住院时间和住院费用分别为（13.39±5.88）d和（31 052.33±9 097.48）元，常规喂养组分别为（16.65±4.27）d和（34 904.06±10 693.14）元，差异均有统计学意义（P<0.05）。两组患儿均未见吻合口瘘、吻合口梗阻等并发症的发生。结论 腹腔镜手术治疗新生儿十二指肠梗阻具有微创、恢复快的优点，术后早期胃肠内营养可促进胃肠功能恢复，缩短静脉营养使用时间及住院天数，减少住院费用，且不增加并发症的发生率。
- Abstract:
- Objective To summarize the experience of mini-invasive laparoscopy and early enteral nutrition (EEN) after surgery for congenital duodenal obstruction and assess its value in fast recovery of congenital duodenal obstruction in neonates.Methods The clinical data of 41 newborns with congenital duodenal obstruction undergoing laparoscopic duodenal anastomosis from January 2017 to October 2018 were retrospectively analyzed.They were divided into two groups according to the postoperative start time of enteral nutrition:EEN group (n=18) and conventional feeding group (n=23).The inter-group differences in days of total parenteral nutrition,time to start feeding,time to full feeding,length of hospital stay,expense and complications were compared.Results 18 cases were identified in the EEN group and 23 cases in the conventional feeding group.There was no statistically significant difference between the two groups in preoperative gestational age,weight,operation age,type of procedure and operation time (P>0.05).Compared to conventional feeding group,days of total parenteral nutrition,time to start feeding,time to full feeding and length of hospital stay were significantly shorter in EEN group[(6.6±1.29) vs.(11.96±4.33) days,(1.17±0.38) vs.(7.74±3.22) days,(6.83±1.25) vs.(12.61±4.36) days and (13.39±5.88) vs.(16.65±4.27) days respectively].The expense in EEN group was significantly less than that in conventional feeding group[(31 052.33±9 097.48) vs.(34 904.06±10 693.14) yuan].There was no complications such as anastomotic fistula and anastomotic stenosis) in neither groups.Conclusion Laparoscopy for newborns with congenital duodenal obstruction offers the advantages of mini-invasion and fast recovery.Early enteral nutrition after surgery can promote the recovery of gastrointestinal function,shorten the duration of parenteral nutrition and hospitalization stay,reduce hospitalization expense and does not increase the incidence of complications.
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备注/Memo
收稿日期:2019-01-07。
基金项目:广东省中医药局科研项目（编号：20162017）
作者简介:肖尚杰,Email:drsiow@163.com