腹腔镜诊治新生儿环状胰腺九例临床分析

Laparoscope diagnosis and treatment for annular pancreas in neonates： report of 9 cases

目的总结腹腔镜诊断和治疗新生儿环状胰腺的初步经验和评价其临床应用价值。方法回顾性分析2009年9月至2013年1月应用腹腔镜诊断和治疗的9例新生儿环状胰腺资料，其中男性5例，女性4例，年龄1～13d。采取5～8mmHg（1mmHg=0．133kPa）低压气腹。8例在腹腔镜明确诊断后于镜下完成十二指肠菱形吻合术，1例采用经稍扩大的脐孔切口进行手术。结果8例患儿在腹腔镜下完成十二指肠菱形吻合术，手术时间为80～140min，平均105min；1例经稍扩大的脐孔切口（约2．5em）手术，手术时间为64min。9例患儿均于腹腔镜术后4—7d（平均5d）进流质饮食，8—14d（平均10d）出院。术后随访3～20个月（平均6．7个月），其中1例合并肛门闭锁患儿术后6个月病死于肺炎。其余患儿疗效满意，症状消失，营养状态及生长发育良好。结论新生儿环状胰腺常通过腹腔镜明确诊断并确定术式。腹腔镜诊治新生儿环状胰腺具有切口小、创伤轻、恢复快等特点，可以在新生儿期安全实施。

Objective To summarize our preliminary experience and evaluate the clinical value of laparoseope diagnosis and treatment for annular pancreas in neonates. Methods A retrospective review of laparoseope diagnosis and treatment for annular pancreas in 9 children from September 2009 to January 2013 was performed. Among them, 5 were male, 4 were female. The age was ranging from 1 to 13 d. A lower- pressure pneumoperitoneum of 5 ~ 8 mm Hg （ 1 mm Hg = 0. 133 kPa） was used. Eight cases of diamond duodenal anastomosis were performed under laparoscope after the diagnosis was established, and 1 case underwent procedure through slightly enlarged umbilical port site. Results Eight cases of diamond duodenal anastomosis were performed under laparoseope, and the operation time was 80 ~ 140 min （mean 105 rain） , in I case it was performed through umbilical port incision, the operation time was 64 min, and the length of incision was about 2.5 cm. Feedings were started at postoperative day 4 to 7 （ mean 5 d） , and patients were discharged at postoperative day 8 to 14 （mean 10 d）. The cases were followed-up for 3 N 20 months （mean 6.7 months） , and 1 case complicated with anal atresia died of pneumonia 6 months later. Other eases were uneventfully recovered and symptoms were alleviated with normal gastroenterological function, no preoperative symptoms recurred, and the nutrition and growth status was excellent. Conclusions Annular pancreas can be diagnosed through laparoscopy. Laparoseope diagnosis and treatment for annular pancreas has the advantages of small incision, micro-invasion and faster recovery, can be safely performed in neonatal period.