腹腔镜手术与开腹手术治疗脐肠瘘的疗效对比

Efficacy of laparoscopy versus open surgery for patent omphalomesenteric duct in neonates

目的介绍一种腹腔镜下手术治疗脐肠瘘的新方式,并与开腹手术进行疗效对比,探讨腹腔镜手术的优势。方法回顾性分析2019年1月至2022年10月在湖南省儿童医院胎儿与新生儿外科住院并接受手术治疗的所有脐肠瘘患儿临床资料。将符合纳入与排除标准的患儿按照手术方式分为腹腔镜手术组和开腹手术组。收集两组患儿一般资料、临床表现、手术时间、开奶时间、住院时间、治疗结果及随访情况,并进行统计学分析。结果共24例患儿符合纳入与排除标准,其中男20例,女4例,年龄3~33 d;12例脐部有大便和气体排出,10例脐部有包块及反复渗液,2例有肠管嵌顿。腹腔镜手术组13例,男12例,女1例;出生胎龄39.4(38.6,40.0)周;入院日龄11.0(7.0,14.5)d;入院体重3.5(2.9,3.9)kg。开腹手术组11例(其中1例为腹腔镜手术中转开腹手术),男8例,女3例;出生胎龄39.8(37.1,40.0)周;入院日龄10.0(6.0,21.0)d;入院体重3.3(3.1,3.5)kg。两组患儿性别、入院体重及年龄差异均无统计学意义(P>0.05),出生胎龄差异有统计学意义(P=0.013)。手术时间:腹腔镜手术组70.0(51.0,95.0)min,开腹手术组64.0(50,70)min,差异无统计学意义(P=0.125);术后开奶时间:腹腔镜手术组为6.0(5.5,7.0)d,开腹手术组为6.0(6.0,7.0)d,差异无统计学意义(P=0.593);住院时间:腹腔镜手术组为14.0(13.0,16.5)d,开腹手术组为14.0(13.0,15.0)d,差异无统计学意义(P=0.338)。两组术后均无一例吻合口瘘发生,顺利恢复至全量喂养后出院;出院后12(6,36)个月随访期间,无一例失访,无瘘管复发及脐肠瘘手术相关再次住院病史。结论腹腔镜手术治疗脐肠瘘安全可行,手术时间、疗效及术后并发症情况与开腹手术无明显差异,可完全保留脐部外观,是一种值得推广的新术式。

Objective To introduce a novel surgical laparoscopic approach for treating patent omphalomesenteric duct(POMD)and compare its efficacy with that of open surgery to understand its advantages.Methods From January 2019 to October 2022,retrospective review was performed for 24 operated POMD children.Based upon different surgical approaches,all eligible children were assigned into two groups of laparoscopy(n=13)and open surgery(n=11).General profiles,clinical manifestations,operative duration,lactation time,hospitalization length and follow-up results of two groups were recorded.Results There were bowel movements and gas discharge from umbilical region(n=12),umbilical mass with recurrent fluid leakage(n=10)and incarcerated intestine(n=2).In laparoscopy group,there were 12 boys and 1 girl with a gestational age at birth 39.4(38.6-40.0)week,an admission age 11.0(7.0-14.5)day and an admission weight 3.5(2.9-3.9)kg.In open surgery group,there were 8 boys and 3 girls with a gestational age at birth 39.8(37.1-40.0)week,an admission age 10.0(6.0-21.0)day and an admission weight 3.3(3.1-3.5)kg.No significant inter-group differences existed in gender,admission weight or age.And gestational age at birth was greater than that of open surgery group(P=0.013).Laparoscopic group had an operative duration of 70.0(51.0-95.0)min and open surgery 64.0(50-70)min.No significant inter-group difference existed in operative duration(P=0.125).Postoperative lactation time was[6.0(5.5-7.0)vs.6.0(6.0-7.0)day].No significant inter-group difference existed(P=0.593).Hospitalization length was 14.0(13.0-16.5)day and open surgery 14.0(13.0-15.0)day.No significant inter-group difference existed(P=0.338).No anastomotic leakage occurred.All of them resumed full feeding and were discharged.During a follow-up period of 12(6-36)months,none became lost.There was no instance of fistula recurrence or re-hospitalization related with surgery.Conclusions Without longer operative duration or more postoperative complications,laparoscopy may preserve the appearance of umbilicus.It is a novel and effective treatment for POMD.