腹腔镜与开腹Ladd手术治疗新生儿肠旋转不良的比较

Comparative Study Between Laparoscopic and Open Ladd ’s Procedure for the Treatment of Congenital Intestinal Malrotation in Neonates

目的比较腹腔镜与开腹Ladd手术治疗新生儿肠旋转不良(排除肠坏死)的效果。方法我院2013年1月~2017年5月对74例新生儿肠旋转不良但不伴肠坏死行开腹(49例)或腹腔镜镜Ladd手术(25例),比较2组患儿手术时间、住院时间、术后并发症等情况。结果腹腔镜组手术时间中位数118、0(86. 5,137. 5) min,明显长于开腹组63. 0(55. 0,70. 5) min(Z=-5. 328,P=0. 001);住院时间中位数13. 0(11. 6,16. 0) d,与开腹组14. 0 (10. 5,21. 0) d无统计学差异(Z=-0. 791,P=0. 729)。2组术后粘连性肠梗阻(χ^2=0. 034,P=0. 853)、再扭转(Fisher精确检验,P=1. 000)、切口感染(Fisher精确检验,P=1. 000)、漏诊(Fisher精确检验,P=0. 338)发生率无统计学差异。结论腹腔镜下Ladd手术治疗于新生儿肠旋转不良,不增加术后并发症,同时具有恢复快,美观等优点,可以在腹腔镜下将肠管顺利复位,使手术顺利完成。

Objective To compare the effect between laparoscopic and open Ladd’s procedure for the treatment of neonatal intestinal malrotation (excluding intestinal necrosis). Methods From January 2013 to May 2017, a total of 74 children who were diagnosed as having neonatal intestinal mrotation without intestinal necrosis were treated in our hospital. They were divided into either open group( n =49) or laparoscopic group( n =45).The operation time, hospital stay, and postoperative complications were compared between the two groups. Results The median operative time was 118.0 (86.5, 137.5) min in the laparoscopic group, which was significantly longer than that in the open group [63.0 (55.0, 70.5) min, Z =-5.328, P =0.001]. The median hospital stay was 13.0 (11.6, 16.0) d in the laparoscopic group and 14.0 (10.5, 21.0) d in the open group, without significant difference ( Z =-0.791, P =0.729). There were no differences between the two groups in postoperative adhesion intestinal obstruction (χ^2 =0.034, P =0.853), re-torsion (Fisher’s exact test, P =1.000), incision infection (Fisher’s exact test, P =1.000), and missed diagnosis (Fisher’s exact test, P =0.338). Conclusions Laparoscopic Ladd’s procedure can be safely used for intestinal malrotation in the neonatal period. It does not increase the complications after operation, and has the advantages of quick recovery and beautiful appearance. It can successfully reposition the intestinal tube under laparoscopy and make the operation complete smoothly.