腹腔镜Ladd手术治疗小儿肠旋转不良

Laparoscopic Ladd’s procedure for intestinal malrotation in children

目的探讨腹腔镜Ladd手术的可行性以及治疗肠旋转不良合并中肠扭转的适合条件。方法2002年7月～2006年3月施行腹腔镜Ladd手术15例。采用三孔技术,腹腔镜下牵拉肠管纠正中肠扭转复位,切断Ladd带、游离十二指肠及全部小肠,最后经腹壁戳孔提出阑尾切除。结果15例在腹腔镜下顺利完成Ladd手术,1例合并十二指肠隔膜、1例合并十二指肠旁疝和1例合并空肠异位胰腺同时完成手术。手术时间45～150min,平均75min。术后1～3d进食,无手术并发症发生,术后住院4～6d,平均5d。12例随访1～42个月,平均21个月,生长发育良好,症状消失。结论腹腔镜Ladd手术是一种安全有效的技术,可以在新生儿期完成,适用于并发亚急性中肠扭转的病儿,对于急性扭转并有腹胀者可能会很困难且危险。

Objective To explore the feasibility of laparoscopic Ladd＇ s procedure and its indications for intestinal malrotation accompanying midgut volvulus. Methods Laparoscopic Ladd＇ s procedure was performed in 15 children from July 2002 to March 2006. The procedure was performed using three trocars. Under laparoscopic visualization, the midgut volvulus was untwisted by grasping and pulling the intestine, the Ladd＇ s band was divided and broadened, the duodenum and the small intestine were mobilized, and finally an appendectomy was performed through an abdominal wall port. Results Laparoscopic Ladd＇ s procedure was completed successfully in the 15 children. Of them, 1 patient with duodenal web, 1 patient with paraduodenal hernia, and 1 patient with ectopic pancreas also had a concomitant procedure. The operative time was 45 - 150 min （mean, 75 min）. The patients began to take food on 1 - 3 postoperative day. There was no surgical complications. The length of postoperative hospital stay ranged 4 - 6 days （ mean, 5 days）. Follow-up observations in 12 patients for 1 -42 months （mean, 21 months） showed normal development and free of symptoms. Conclusions＇ Laparoscopic Ladd＇s procedure is a safe and effective technique. It can be performed in neonates and applicable subacute midgut volvulus, but may be unadvisable for acute volvulus with abdominal distention.