经腹腔镜治疗婴儿先天性肥厚性幽门环肌狭窄及先天性巨结肠

Treatment of congenital hypertrophic pyrolic stenosis and Hirschsprung's disease under laparoscopy

目的总结使用腹腔镜治疗新生儿、婴儿先天性肥厚性幽门环肌狭窄及先天性巨结肠的经验。方法20例患儿年龄16～120d,体重2.7～8kg。先天性肥厚性幽门狭窄和先天性巨结肠各10例。在气管插管加单次骶管阻滞麻醉下,建立CO2气腹,注气压力为1.6～1.9kPa,流量为3L/min。置入腹腔镜,并根据不同的病种在不同的部位置入操作钳,完成幽门环肌切开术和辅助巨结肠根治术。结果手术时间为25～150min,术后3～7d出院。均无并发症发生。结论腹腔镜技术在新生儿、婴儿应用安全可靠,手术打击小。

Objective To present our experience with laparoscopic pyloromyotomy and laparoscopically assisted endorectal pull through for Hirschsprung's disease (HD) in newborns and infants.Methods Twenty newborns or infants with hypertrophic pyloric stenosis and HD,age ranged from 16～120 days and weight from 2.7～8 kg.Under epidural anesthesia and tracheal intubation,carbon dioxide was insufflated into abdominal cavity via a Veress needle,reaching an insufflative pressure of 12～14 mm Hg.One umbilical and two or three subcostal canulas for instrumentation were demanded.The pyloromyotomy was performed in patients with hypertrophic pyrolic stenosis and in patients with HD the affected colon and rectum were mobilized by dissecting the supplying vessels and cutting the peritoneal reflection,and pull-through procedure was carried out.Results The operation time was 25～150 minutes with rare complications.Oral feeding was resumed on the following day postoperation.The patients recovered and discharged from hospital 3～7 days after operation.Conclusions Laparoscopic pyloromyotomy and laparoscopic endorectal pull-through for HD in newborns and infants are safe and feasible.The advantages of this procedure include minimal trauma to abdomen,rapid restoration of stomach and bowel function and quick rehabilitation.