腹腔镜十二指肠空肠吻合术在儿童肠系膜上动脉综合征中的应用

目的探讨腹腔镜十二指肠空肠吻合术在儿童肠系膜上动脉综合征中的疗效。方法回顾性分析2015年1月至2018年1月华中科技大学同济医学院附属武汉儿童医院普外科4例肠系膜上动脉综合征患儿,经保守治疗失败后,行腹腔镜十二指肠空肠吻合术,收集其临床资料,观察其并发症发生情况及术后疗效。结果本组4例患儿中,男1例,女3例,经保守治疗,症状无缓解或反复发作者行腹腔镜十二指肠空肠侧侧吻合术,所有手术过程进行顺利,平均手术时间150 min,术后无明显梗阻、吻合口漏及吻合口狭窄等手术并发症,术后呕吐及腹痛等症状缓解,术后1个月平均体重增加5.25 kg,身体质量指数增大到17.6 kg/m^2。结论腹腔镜十二指肠空肠吻合术治疗儿童肠系膜上动脉综合征具有良好疗效,具有手术方式相对简单易操作、并发症少,复发率低等优点,但吻合时吻合口要宽大,避免术后吻合口狭窄,吻合位置要尽量靠近梗阻位置,能无张力吻合即可,以减少无功能肠管长度及盲袢综合征的发生。

Application of laparoscopic duodenojejunostomy for children with superior mesenteric artery syndrome

Objective To evaluate the efficacy of laparoscopic duodenojejunostomy for superior mesenteric artery syndrome(SMAS)in children.Methods Between 2015 to 2018,4 SMAS children underwent laparoscopic duodenojejunostomy after a failure of conservative measures.For evaluating surgical efficacies,their clinical data and postoperative complications were recorded and analyzed.Results There were 1 boy and 3 girls.All of them were emaciated and slender.There was a sudden postprandial onset of bilious vomiting and abdominal pain.The average duration of illness was 1 month.Disturbances of water and electrolyte and malnutrition were quite common.However,symptomatic relief in knee-chest posture and wave of reverse peristalsis were not obvious.Their average weight at admission was 22.5 kg and body mass index(BMI)14.2 kg/m2.Upper gastrointestinal radiography revealed obstruction of the third part of duodenum.And abdominal CT indicated an aortomesenteric angle of 13°and an aortomensenteric distance of 7 mm with gastric and proximal duodenal dilatation.If conservative measures failed,laparoscopic duodenojejunostomy was performed.The average operation time was 150 min.There were no postoperative complications such as obstruction,anastomotic leakage or anastomotic stenosis.Vomiting and abdominal pain were relieved.A month later,there was an average weight gain of 5.25 kg and BMI increased to 17.6 kg/m^2.Conclusions Laparoscopic duodenojejunostomy is both simple and efficacious for SMAS with fewer postoperative complications and a lower recurrence rate in children.During operation,anastomosis should be large enough to avoid stenosis and anastomotic site should be close to obstruction site for reducing the length of non-functional bowel and lowering the incidence of blind loop syndrome.