早产低体重儿胸、腹腔镜同期手术3例

Simultaneous Thoraco-laparoscopic Surgery in 3 Premature and Low Weight Newborns

目的探讨早产低体重儿胸、腹腔镜同期手术的可行性。方法回顾性分析2020年3例早产低体重儿食管闭锁(Ⅲ型)合并腹腔消化道畸形同期行胸、腹腔镜手术的资料。出生孕周32^(+6)、36^(+5)、36^(+4),体重1640、2100、1500 g。先左侧卧位行胸腔镜食管气管瘘结扎+食管端端吻合术,再改仰卧位行腹腔镜手术,1例空肠隔膜闭锁行空肠隔膜切除纵切横缝术,2例十二指肠闭锁行十二指肠菱形吻合术。结果手术均获成功,无术中并发症。1例术后6周食管吻合口狭窄(2 mm)行球囊扩张。随访16、14、16个月,食管造影显示吻合口通畅,无吞咽困难,生长发育与同龄无差异。结论早产低体重儿胸、腹腔镜同期手术是可行的,但尚需大样本研究支持。

Objective To evaluate the feasibility of simultaneous thoraco-laparoscopic surgery in premature and low weight newborns.Methods Clinical data of 3 preterm and low weight newborns with esophageal atresia(typeⅢ)and abdominal digestive malformation who underwent thoraco-laparoscopic repair surgery in 2020 were retrospectively analyzed.The gestational week were 32^(+6),36^(+5),and 36^(+4) weeks,and the birth weight were 1640,2100,and 1500 g.First,thoracoscopic esophagotracheal fistula ligation and esophagoesophageal end-to-end anastomosis was performed in left lateral position,and then laparoscopic surgery was performed in supine position.Jejunal diaphragm resection was performed in 1 case with jejunal atresia,and duodenal diamond-shaped anastomosis was performed in 2 cases with duodenal atresia.Results All the operations were successful without complications.One case had esophageal anastomotic stenosis(2 mm)after 6 weeks of surgery and was operated with balloon dilation.The patients were followed up for 16,14 and 16 months.Esophagography showed that the anastomosis was unobstructed.No dysphagia was observed.There was no difference in growth and development between them and their peers.Conclusion Simultaneous thoraco-laparoscopic surgery for preterm and low weight newborns is feasible,but it still needs the support of large sample studies.