腹腔镜下吻合术治疗新生儿十二指肠梗阻

Laparoscopic Anastomosis for Neonatal Duodenal Obstruction

目的探讨腹腔镜下吻合术治疗新生儿十二指肠梗阻(congenital duodenal obstruction,CDO)的疗效。方法回顾分析2008年12月～2011年9月53例CDO患者临床资料。腹腔镜组27例,Ⅱ型、Ⅲ型十二指肠闭锁及环状胰腺15例行十二指肠菱形吻合术,十二指肠狭窄及Ⅰ型十二指肠闭锁8例行十二指肠纵切横缝术,4例Ⅰ型十二指肠闭锁行十二指肠菱形吻合术;开腹组26例,以上3种术式分别为12例、8例、6例。对比2组手术时间、术后住院时间、术后进食时间、住院费用及术后并发症情况。结果与开腹组相比,腹腔镜组术后进食时间早[(5.8±1.6)d vs.(7.5±2.2)d,t=-3.060,P=0.004],但手术时间长[(113.8±39.2)min vs.(94.0±31.0)min,t=2.034,P=0.047]。2组术后住院时间和住院费用、并发症发生率差异无显著性(P>0.05)。结论腔镜下吻合术治疗新生儿十二指肠梗阻疗效肯定,在术后肠功能恢复上明显优于传统开腹手术。

Objective To evaluate the curative effect of laparoscopic anastomosis for neonates with congenital duodenal obstruction （CDO）. Methods From December 2008 to September 2011, we retrospectively analyzed the clinical data of 53 cases with CDO. Among the cases, 27 underwent laparoscopic duodenal sutured anastomosis and the other 26 received open surgery. Eight patients from the laparoseopic group and 8 patients from the open group, who had duodenal stenosis complicated with type I duodenum atresia, underwent a partial excision of the diaphragm after vertical incision of the anterior part in the du0denum, followed by a transverse suture; 15 and 12 cases from the laparoscopic and open groups respectively, who had type H or m duodenal atresia and annular pancreas, and 4 and 6 cases from the two groups, who had type I duodenum atresia complicated with fibrosis of the intestinal wall, received diamond-shaped side-to-side duodenoduodenal anastomosis. The operation time, postoperative hospital stay, time for postoperative diet, hospital cost, and postoperative complications were compared between the two groups. Results The laparoseopic group recovered postoperative diet earlier, but had longer operation time than the open group [ （5.8± 1.6） d vs. （7.5 ± 2.2） d, t = - 3. 060, P = 0. 004 ; （ 113.8 ± 39.2 ） rain vs. （94.0 ± 31. 0） min, t = 2. 034, P = 0. 047 ]. No significantly difference was observed in the postoperative hospital stay, hospital cost, and rate of postoperative complications between the two groups （ P 〉 0. 05 ）. Conclusion Laparoscopic anastomosis is effective for neonates with CDO, and it is superior to open surgery in the postoperative recovery of gastrointestinal function.