经脐单部位腹腔镜手术联合术后早期肠内营养在先天性十二指肠梗阻快速康复中的应用效果

Application of transumbilical single-site laparoscopic surgery combined with early enteral nutrition in rapid recovery of congenital duodenal obstruction

目的探讨经脐单部位腹腔镜手术联合术后早期肠内营养(EEN)在先天性十二指肠梗阻患儿快速康复中的应用价值。方法分析87例十二指肠梗阻新生儿临床资料,将采用三孔法腹腔镜治疗的39例患儿纳入三孔组,将经脐单部位腹腔镜治疗的48例患儿按照术后喂养方式分成单孔组(常规喂养)26例和单孔EEN组22例。比较各组手术时间、术后肠功能恢复时间、住院时间及费用、实验室指标及并发症等方面的差异。结果3组手术时间比较差异无统计学意义。与三孔组比较,单孔组术后初次肠内营养时间、达到全量肠内营养时间、术后首次排便时间、术后住院时间、住院费用及术后1周白蛋白(ALB)、血红蛋白(Hb)及C-反应蛋白(CRP)水平差异无统计学意义。与单孔组比较,单孔EEN组术后初次肠内营养时间、达到全量肠内营养时间、术后首次排便时间、术后住院时间均明显缩短(P<0.05),术后1周Hb水平增高(P<0.05),住院费用及术后1周ALB、CRP水平差异无统计学意义。术后随访,三孔组及单孔组各有1例患儿出现肠扭转复发,经再手术后治愈。结论经脐单部位腹腔镜手术联合EEN治疗先天性十二指肠梗阻安全、可行、有效,可促进术后早期恢复,且腹部切口隐匿,具有较好的临床应用价值。

Objective To investigate the application value of transumbilical single-site laparoscopic surgery combined with early postoperative enteral nutrition(EEN)in rapid recovery of congenital duodenal obstruction.Methods Clinical data of 87 children with duodenal obstruction were analyzed.The children who received three-hole laparoscopic treatment were classified as the three-hole group(n=39),and children who received transumbilical single-site laparoscopic treatment were divided into the single-hole group(conventional feeding,n=26)and the single-hole EEN group(EEN,n=22)according to different postoperative feeding methods.The differences of operation time,postoperative intestinal function recovery time,hospital stay and cost,laboratory indicators and complications were compared between the three groups.Results There was no significant difference in operation time between the three groups(P>0.05).There were no significant differences in the time of initial enteral nutrition,the time to total enteral nutrition,the time of first defecation,the time of postoperative hospitalization,the cost of hospitalization and levels of albumin(ALB),hemoglobin(Hb)and C-reactive protein(CRP)one week after surgery between the single-hole group and the three-hole group(P>0.05).The time of initial enteral nutrition,the time of total enteral nutrition,the time of first defecation,the time of postoperative hospitalization were significantly shortened in the single-hole EEN group than those of the single-hole group(P<0.05),and the Hb level was higher one week after surgery(P<0.05).There were no significant differences in hospital expenses,ALB and CRP levels one week after surgery between the two groups(P>0.05).During follow-up after discharge,there was one case of recurrent intestinal torsion in the single-hole group and the three-hole group,which were cured after re-operation.Conclusion In the treatment of neonatal duodenal obstruction,transumbilical single-site laparoscopic surgery combined with early enteral nutrition is safe,feasible and effective,which can promote early postoperative recovery.The abdominal incision is hidden,which has good clinical application value.