Zou Chanjuan,Li Bo,Dong Jie,et al.Laparoscopic “spindle” repositioning approach for neonatal congenital intestinal malrotation[J].Journal of Clinical Pediatric Surgery,2023,22(10):944-947.[doi:10.3760/cma.j.cn101785-202306041-008]
“纺锤式”复位法在新生儿先天性肠旋转不良中的应用研究
- Title:
- Laparoscopic “spindle” repositioning approach for neonatal congenital intestinal malrotation
- Keywords:
- Congenital Intestinal Malrotation; Surgical Procedures; Operative; Laparoscopy; Infant; Neonates
- 摘要:
- 目的 介绍一种"纺锤式"肠扭转复位方式治疗肠旋转不良,分析该方法治疗新生儿先天性肠旋转不良的可行性。方法 回顾性分析湖南省儿童医院新生儿外科2015年1月至2021年6月诊断为先天性肠旋转不良患儿的临床资料。按照纳排标准共收集228例,其中男96例、女132例,年龄8(3,28)d,体重3.5(2.0,4.3)kg。收集患儿围手术期临床资料及随访结果。结果 228例均经造影检查诊断为先天性肠旋转不良,其中174例(174/228,77.6%)因呕吐首次就诊;48例(48/228,21.4%)临床表现为便血;6例(6/228,2.6%)因其他原因行腹部彩超检查发现。手术均在腹腔镜下进行,手术时间(58±15)min,术后开奶时间2.5(1,4)d,住院时间11(9,18)d。44例中转开腹手术,主要原因包括:肠管扩张积气25例(25/44,56.8%)、合并梅克尔憩室15例(15/44,31.8%)、系膜血管破裂腔镜下难以止血4例(4/44,9.0%)。9例术中诊断为肠扭转复发,复发时间最早发生在术后第10天,最晚出现于术后2年6个月。肠扭转复发患儿经二次手术治疗后均治愈出院,末次随访时所有患儿生长发育正常,无一例复发。4例出院后喂养过程中出现呕吐,经保守治疗后好转。结论 腹腔镜下"纺锤式"复位法治疗新生儿先天性肠旋转不良,操作简单,复位时间短,疗效好,手术容易掌握,可作为一种新的肠扭转复位方法推广。
- Abstract:
- Objective To introduce a new laparoscopic "spindle" repositioning approach for managing neonatal congenital intestinal malrotation (CIM) and analyze its efficacy and feasibility.Methods From January 2015 to June 2021,228 CIM children were collected.There were 96 boys and 132 girls with an age range of 8(3-28) days and a weight range of 3.5(2.0-4.3) Kg.Perioperative data and follow-up outcomes were recorded.Measurements with a normal distribution were described by mean and standard deviation while measurements with an abnormal distribution by median and interquartile range.The categorical variables are statistically described in terms of frequency and percentage.Results Among them,174(77.6%) were initially diagnosed with vomiting.And 48 cases (21.4%) had a clinical presentation of bloody stool.And 6 cases (2.6%) were detected incidentally during abdominal ultrasonography for other reasons.A definite diagnosis of CIM was confirmed after contrast study.Average duration of procedure was (58±15) min,postoperative milk resumption time 2.5(1-4) days and hospitalization stay 11.0(9-18) days.Forty-four patients underwent open surgery.The main reasons for converting into open surgery included pneumatization of dilated bowel (n=25,56.8%),concurrent Michael’s diverticulum (n=14,31.8%) and lumpectomic difficulty in achieving hemostasis during laparoscopy (n=4,9.0%).During follow-ups,9 cases of recurrent CIM occurred at Day 10 to Month 30.After re-operation,all of them were discharged and recovered well at the final follow-up.Four children had vomiting during feeding post-discharge and improved after conservative measures.Conclusion Laparoscopic "spindle" repositioning approach for CIM is simple,convenient and easy-to-master in neonates.Wider popularization is worthwhile.
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备注/Memo
收稿日期:2023-6-26。
基金项目:湖南省出生缺陷协同防治科技重大专项(2019SK1015)
通讯作者:周崇高,Email:zhoucg_hnch@163.com