腹腔镜下十二指肠单层缝合吻合术的实验研究与临床应用

The experimental studies and clinical applications of laparoscopic duodenal single-layer sutured anastomosis in children.

目的 通过动物实验探索腹腔镜下十二指肠单层缝合吻合术的可靠方法,并应用于临床.方法 采用新西兰大白兔模拟婴幼儿腹腔环境,分连续缝合和间断缝合两组进行十二指肠单层缝合吻合术;应用于先天性十二指肠梗阻患儿,采用低压气腹、右肝悬吊技术,实施单层缝合吻合重建手术.结果 实验兔连续缝合时间[（27.0±7.25）min],比间断缝合时间[（38.8±5.07）min]明显缩短;间断缝合和连续缝合在吻合口径和吻合口耐受压力上比较无差异.12例患儿均在腹腔镜下明确病因并成功矫治,6例十二指肠隔膜狭窄患儿采取纵切横行缝合吻合术、4例十二指肠闭锁和2例环状胰腺患儿采取十二指肠菱形吻合术.1例术后发生暂时性吻合口漏经引流3 d自愈,其余于术后3～6 d开始进食,7～12 d痊愈出院.术后随诊吻合口通畅.结论 腹腔镜下十二指肠单层缝合吻合术安全可靠,但须防止吻合口黏膜外翻,以免发生吻合口漏.

Objective To explore the reliable method of a laparoscopic single-layer duodenal sutured anastomosis in the animal experiments and clinical application. Methods The ten rabbits were pretended to simulate the abdominal environment of newborn and infant. They were randomly divided into the continuous su- ture group and the interrupted suture group to carry out the single-layer diamond-shaped anastomosis in the duo- denum. A single-layer full-thickness sutured anastomosis was applied in 12 children with congenital duodenal obstruction（CDO）. Under the laparoscopic visualization, the cause of duodenal obstruction was explored and a single-layer sutured anastomosis was performed. Results The anastomotic time was 38.8 -＋ 5.07rain in the in- terrupted suture group and 27.0 ± 7.25rain in the continuous suture group, the continuous suture time took shorter than the interrupted suture time （t = 2. 984, P = 0. 017 ）. The laparotomy after laparoscopic procedure in two groups showed good patency of＇ tile anastomosis and no leakage. The tolerant pressure of the anastomosis wash＇ t found the significant difference between the two groups. The etiology of 12 cases was laparoscopically i- dentified and all procedures were successfully performed. Six cases with duodenal diaphragmatic stenosis were encountered a partial excision of the diaphragm after vertical incision of the anterior part in the duodenum fol- lowed by a transverse suture. A diamond-shaped full-thickness duodenoduodenal anastomosis was completed in 4 cases with duodenal atresia and 2 annular pancreas. The operative time was 60 - 150 rain. There was no iutr- aoperative complications and blood transfusion. Except 1 neonate with transient anastomotic leak was cured by draining for 3 days （from day 2 to 4 postoperatively） without another intervention. All children were cured and the postoPerative period of hospital stay was 7 to 12 days. Conclusion The hand-sewn single-layer anastomo- sis is carried out that it avoids mucosal eversion. If the mucosal eversion occured, the anastomotic tolerant pressure would decrease significantly and prone to anastomotic leakage. The single-layer interrupted and continuous suture anastomosis could achieve satisfactory effect, but the continuous suture is more convenient and time-saving comparing with the interrupted suture under the laparoscope.