腹腔镜下单层吻合重建术在新生儿十二指肠梗阻和胆总管囊肿治疗中效果观察

The effect of laparoscopic single-layer anastomosis in neonatal duodenal obstruction and chole-dochal cyst

目的探讨腹腔镜下消化道单层缝合吻合重建术在十二指肠梗阻和胆总管囊肿治疗中的应用价值。方法选取我院收治的134例十二指肠梗阻或胆总管囊肿新生儿作为研究对象,根据手术方式的不同分为4组:采用腹腔镜行消化道单层缝合吻合重建的12例先天性胆总管囊肿为观察1组,采用腹腔镜行消化道单层缝合吻合重建的58例先天性十二指肠梗阻为观察2组;采用传统开腹手术的18例先天性胆总管囊肿为对照1组,采用传统开腹手术的46例先天性十二指肠梗阻为对照2组。比较对照组和观察组的手术疗效、手术时间、术后并发症发生率等。结果观察1组病儿的手术时间、肠功能恢复时间、住院时间分别为(122.54±25.47)min、(3.25±0.66)d、(6.54±1.24)d;对照1组病儿的手术时间、肠功能恢复时间、住院时间分别为(90.54±16.57)min、(4.74±1.04)d、(10.24±2.01)d。观察2组病儿的手术时间、肠功能恢复时间、住院时间分别为(120.39±24.87)min、(3.31±0.67)d、(6.18±1.16)d;对照2组病儿的手术时间、肠功能恢复时间、住院时间分别为(92.47±16.33)min、(4.68±0.98)d、(9.68±1.68)d。观察组时间均明显短于对照组,差异有统计学差异(P<0.05)。两组病儿经手术治疗后,消化道畸形均成功得到矫治,观察组无中转开腹病例。观察组术后的并发症发生率为1.43%,对照组为10.94%,组间比较差异有统计学意义(P<0.05)。结论腹腔镜下消化道单层缝合吻合重建术治疗十二指肠梗阻和胆总管囊肿的疗效确切,且操作简单、用时较短、创伤小,病儿术后恢复更快。

Objective To explore the application of laparoscopic chondrocyte suture anastomosis in the treatment of duodenal obstruction and choledochal cyst. Methods A total of 134 cases duodenal obstruction or common bile duct cyst patients were enrolled in this study and were divided into 4 groups：12 cases of congenital choledochal cysts as the observation group 1,58 cases of congenital duodenal obstruction as the observation group 2,18 cases of congenital choledochal cyst as the control group 1 and 46 cases of congenital duodenal obstruction as the control group 2. The observation group underwent the laparoscopic resection of gastrointestinal single suture anastomosis,the control underwent traditional open surgery. And the operative outcomes,operation time and postoperative complications were compared within groups. Results The time of operation,the recovery time of intestinal function and the length of hospital stay in the observation group 1 were（122. 54 ± 25. 47） min,（3. 25 ± 0. 66） d and（6. 54 ± 1. 24） days respectively. In the control group 1,（90. 54 ± 16. 57） min,（4. 74 ± 1. 04） d,（10. 24 ± 2. 01） d,respectively. In the observation group 2 were（120. 39 ± 24. 87） min,（ 3. 31 ± 0. 67） d and（ 6. 18 ± 1. 16） days respectively. In the control group 2 were（92. 47 ± 16. 33） min,（4. 68 ± 0. 98） d,（9. 68 ± 1. 68） d,respectively. The time of operation,the recovery time of intestinal function and the length of hospital sta in observation groups were significantly shorter than the control groups（ P〈0. 05）. After surgery,all patietns＇ gastrointestinal malformations were successfully treated. The observation group had no cases conversion to open surgery. The incidence of postoperative complication in the observation and the control group were1. 43% and 10. 94%,respectively（ P〈0. 05）. Conclusion Laparoscopic chondrocyte suture anastomosis can be used in treatment of duodenal obstruction and choledochal cyst,which is simple and easy to operate,with less trauma and quicker recovery after operation.