悬吊牵引技术在腹腔镜下十二指肠吻合术中的应用价值分析

Application of suspension traction in laparoscopic suture anastomosis of duodenum

目的探讨十二指肠悬吊牵引技术在腹腔镜十二指肠吻合手术中的应用价值。方法回顾性分析我院2009年9月至2014年05月应用腹腔镜手术治疗先天性十二指肠梗阻42例患儿的临床资料。依据手术是否采用悬吊牵引技术将所有病例分为两组，即A组（常规手术组）13例：十二指肠隔膜闭锁7例、环形胰腺6例，B组（悬吊牵引组）29例：十二指肠隔膜闭锁16例、十二指肠Ⅱ型闭锁3例、环形胰腺10例。腹腔镜下十二指肠吻合术均采用三孔法，隔膜闭锁采用十二指肠纵切横缝、Ⅱ型闭锁及环形胰腺采用十二指肠菱形吻合术，比较两组手术时间、术中出血量、中转开腹、术后吻合口漏、狭窄、初次进食时间，术后足量进食时间等情况。结果A组中十二指肠纵切横缝术手术时间（87．3±13．2）min。十二指肠菱形吻合术手术时间（135．7±20．8）min，2例中转开腹手术，1例患儿出现吻合口漏经保守治疗充分引流治愈，1例患儿术后1个月出现复发胆汁性呕吐经保守治疗治愈。B组中十二指肠纵切横缝术手术时间（77．1±11．5）min，十二指肠菱形吻合术手术时间（115．7±16．5）min，无中转开腹。无术中、术后并发症。结论悬吊牵引技术应用于腹腔镜十二指肠吻合术可良好显露术野。方便手术操作，降低手术操作难度，缩短了手术操作时间，疗效安全可靠。

Objective To explore the application value of suspension traction in laparoscopic suture anastomosis of duodenum. Methods Retrospective analyses were conducted for the clinical data of 42 cases with congenital duodenal obstruction （CDO）. They were divided into groups A and B according to whether or not suspension traction was applied. Group A （convention, n = 13） ： duodenal membrane atresia （n = 7） and annular pancreas （n = 6）; Group B （suspension traction, n = 29）： duodenal membrane atresia （n = 16）, duodenal atresia Ⅱ type （n = 3） and annular pancreas （n = 10）. Three laparoscopic holes were employed in all cases to compare operative duration, number of conversion into open surgery, postoperative stomal leak, anastomotic stenosis, feeding start time and full feeding time, etc. Results Comparing Groups A and B, the operative duration for vertical incision of anterior duodenum plus a transverse suture was（87. 3 ± 13. 2）vs （77. 1 ± 11.5） rain and diamond- shaped side-to-side anastomosis （135.7 ± 20. 8） vs （77. 1 ± 11.5） min. In Group. A, there were conversion into open surgery （n = 2）, anastomotic fistula cured by conservative drainage （n = 1） and repeated emesis cured conservatively （n = 1 ）. Neither conversion into open surgery nor complication occurred during or after operation. Conclusions The application of suspension traction provides excellent exposure and operative convenience in laparoscopic suture anastomosis of duodenum. And operative difficulty is reduced with shortened time and enhanced safety.