论文部分内容阅读
目的评价腹腔镜诊断和治疗新生儿先天性十二指肠梗阻(CDO)的可行性和疗效。方法回顾性分析2002年7月-2010年10月新生儿CDO患儿21例行腹腔镜手术的临床资料,腹腔镜下探查病因,并依据其病理类型予以相应手术矫治。结果 21例患儿均在腹腔镜下明确诊断,并顺利完成手术,肠旋转不良13例实施Ladd手术,十二指肠狭窄4例腔镜下纵行切开其前壁横行缝合,十二指肠闭锁2例和环状胰腺2例成功进行空肠十二指肠菱形吻合术。手术时间(73.0±21.3)m in(45~135 m in),除1例术后发生暂时性吻合口漏,给予禁食水及肠外营养处理自愈外,无术中并发症出现。术后上消化道造影检查吻合口通畅,术后7~12 d痊愈出院。随访(31.3±4.8)个月,患儿生长发育正常。仅1例术后2个月出现肠黏连梗阻,予手术松解治愈。结论腹腔镜诊治新生儿CDO是一种安全有效的方法,具有创伤小、进食早、恢复快、美观等特点。但新生儿期腹腔镜手术对麻醉及围术期管理要求更高。
Objective To evaluate the feasibility and efficacy of laparoscopic diagnosis and treatment of neonatal congenital duodenal obstruction (CDO). Methods The clinical data of 21 patients undergoing laparoscopy in neonates with CDO from July 2002 to October 2010 were analyzed retrospectively. The etiology of laparoscopic exploration was analyzed retrospectively. Results All the 21 cases were diagnosed laparoscopically, and the operation was successfully completed. In 13 cases with poor bowel rotation, Ladd operation was performed. In 4 cases of duodenal stricture, the anterior wall was stitched longitudinally and stitched transversely. The twelve fingers Intestinal atresia in 2 cases and 2 cases of annular pancreas successful jejunum duodenal anastomosis. Surgery time (73.0 ± 21.3) m in (45 ~ 135 mins), except for one case of transient anastomotic leakage, given fasting water and parenteral nutrition treatment of self-healing, no intraoperative complications occurred. Postoperative upper gastrointestinal contrast anastomotic patency, 7 to 12 days after surgery cured. Follow-up (31.3 ± 4.8) months, children with normal growth and development. Only 1 case 2 months after the occurrence of intestinal adhesion obstruction, to be cured by surgery. Conclusion Laparoscopic diagnosis and treatment of neonatal CDO is a safe and effective method, with less trauma, early feeding, quick recovery, good appearance and so on. Neonatal laparoscopic surgery and anesthesia and perioperative management requirements are higher.