新生儿腹腔镜Ladd's术后再手术经验教训

Lessons learned from reoperation after neonatal Ladd's laparoscope

目的分析腹腔镜Ladd's术治疗新生儿肠旋转不良术后近期再手术的原因并提出防范措施。方法回顾性分析武汉儿童医院新生儿外科2012年1月至2018年6月间一期完成的98例新生儿肠旋转不良腹腔镜Ladd's术后患儿的恢复情况(不包括中转开腹病例)。结果98例中90例顺利出院,另8例患儿术后1~3周内再次手术。其中7例因胃肠减压持续多量胆汁或喂养增量困难,消化道碘水造影提示十二指肠不全肠梗阻再手术;另1例术后1周行X线片检查发现气腹再手术。此8例患儿二次手术后2周均痊愈出院。术后随访3个月,均恢复顺利。结论新生儿先天性肠旋转不良经腹腔镜行Ladd's术是一种安全可靠的方法,具有创伤小切口美观的优点。但术者因经验及操作技能不足的原因可能出现松解Ladd's索带不彻底、小肠系膜扩展不充分或其他意外导致患儿再手术。术后2周内胃肠减压持续多量胆汁或喂养增量困难的患儿,应及时行腹部X线立位平片及消化道碘水造影检查,为再次手术提供依据。

Objective To analyze the causes and countermeasures of laparoscopic Ladd's reoperation for congenital intestinal malrotation.Methods Retrospective analysis was performed for 98 laparoscopic children from January 2012 to June 2018.Results Among them,90 cases were discharged smoothly while another 8 cases underwent re-operation at 1-3 weeks post-operation.There were a massive production of bile through continuous gastrointestinal decompression,feeding intolerance and duodenal incomplete obstruction on upper gastrointestinal series(n=7)and postoperative radiographic evidence of pneumoperitoneum(n=1).All 8 cases were discharged within 2 weeks after a second operation.Postoperative recovery was uneventful during a follow-up period of 3 months.Conclusions Laparoscope is both safe and efficacious for congenital intestinal malrotation with minimal trauma and an excellent cutting edge.However,unsophisticated handling and insufficient experiences may cause reoperation because of releasing Ladd's ligament incompletely or extending mesentery inadequately.Timely re-examinations are vital for follow-up inspections.