小儿腹腔镜下先天性十二指肠梗阻的诊治

Laparoscopic diagnosis and treatment of congenital duodenal obstruction in children

目的 评价腹腔镜对先天性十二指肠梗阻的诊断和治疗的可行性。方法 本组10 例,年龄5d^10岁。采用3或4 Trocar技术,腹腔镜下确定十二指肠梗阻病因并予以手术治疗。5 例新生儿肠旋转不良完成Ladd’s手术,1例新生儿和2例婴儿诊断十二指肠隔膜纵行切开其前壁后切除隔膜、横行缝合,2例女孩确立为肠系膜上动脉综合征,腹腔镜下松解Treitz韧带,离断空肠经结肠后与十二指肠Roux Y吻合。结果 全部手术操作均在腹腔镜下顺利完成,手术时间1~3.5h,术后1~3d进食、5~7d痊愈出院,无并发症出现。结论 经腹腔镜诊治先天性十二指肠梗阻是一种安全有效的方法,腹腔镜技术具有切口小、进食早、住院时间短和并发症少等特点,明显优于传统开腹手术。

Objective This clinical study was undertaken to evaluate the feasibility of a laparoscopic approach for the diagnosis and treatment of congenital duodenal obstruction.Methods Ten children, aged 5 days to 10 years, underwent laparoscopic surgery. The procedure was performed using 3 or 4 trocars of 3.5mm to 5.5mm diameter. The causes of duodenal obstruction were diagnosed and operated. A standard Ladd's procedure was performed in 5 neonates with malrotation. One newborn and 2 infants with duodenal web necessitated a partial excision of the diaphragm. Two girls had superior mesenteric artery syndrome(SMAS) and underwent laparoscopic lysis of Treitz's ligament and Roux-en-Y duodenojejunostomy.Results All procedures were completed successfully. Operative times ranged from 1 to 3.5 hours. Feedings was started on postoperative day 1 to 3. Hospital stay ranged from 5 to 7 days. There was no complication.Conclusions Laparoscopy is a safe and excellent technique for the diagnosis and operative management of duodenal obstruction.