腹腔镜下吻合术治疗新生儿十二指肠梗阻

目的探讨腹腔镜下吻合术治疗新生儿十二指肠梗阻(congenital duodenal obstruction,CDO)的疗效。方法回顾分析2008年12月～2011年9月53例CDO患者临床资料。腹腔镜组27例,Ⅱ型、Ⅲ型十二指肠闭锁及环状胰腺15例行十二指肠菱形吻合术,十二指肠狭窄及Ⅰ型十二指肠闭锁8例行十二指肠纵切横缝术,4例Ⅰ型十二指肠闭锁行十二指肠菱形吻合术;开腹组26例,以上3种术式分别为12例、8例、6例。对比2组手术时间、术后住院时间、术后进食时间、住院费用及术后并发症情况。结果与开腹组相比,腹腔镜组术后进食时间早[(5.8±1.6)d vs.(7.5±2.2)d,t=-3.060,P=0.004],但手术时间长[(113.8±39.2)min vs.(94.0±31.0)min,t=2.034,P=0.047]。2组术后住院时间和住院费用、并发症发生率差异无显著性(P>0.05)。结论腔镜下吻合术治疗新生儿十二指肠梗阻疗效肯定,在术后肠功能恢复上明显优于传统开腹手术。     

小儿免钉合器腹腔镜胃空肠缝合吻合术

目的探讨腹腔镜下胃空肠缝合吻合手术的方法、安全性和有效性。方法2005年5月～9月，对3例小儿胃流出道梗阻病儿进行腹腔镜下胃空肠缝合吻合术，2例幽门狭窄继发于消化性溃疡同时行高选择性迷走神经切断术。将一段空肠经结肠前上提靠近胃窦部，先浆肌层连续缝合胃空肠固定在一起，超声刀切开胃壁和毗邻空肠，分别连续全层缝合胃空肠侧壁，再间断浆肌层缝合加固。结果3例全部在腹腔镜下完成胃空肠缝合吻合，手术时间分别为135、150、180min，3例术后住院时间均为6d。无并发症发生。各随访8、10和12个月饮食正常，营养状况良好。结论腹腔镜胃空肠缝合吻合术是一种安全可行的技术，创伤小，恢复快且美观。     

腹腔镜治疗新生儿先天性十二指肠梗阻的围手术期护理

<正>先天性十二指肠梗阻是新生儿常见的消化道发育畸形,按病因分为内源性和外源性两种。常见的内源性疾病系十二指肠本身肠管发育过程受阻导致十二指肠闭锁或狭窄;常见的外源性疾病包括由于胰腺始基未消失形成的环状胰腺     

腹腔镜诊治新生儿先天性十二指肠梗阻54例

目的 总结腹腔镜诊治新生儿十二指肠梗阻的经验.方法 回顾性分析2015年10月～2019年5月54例新生儿先天性十二指肠梗阻资料.年龄1～26 d,中位数1 d;出生体重1155～4400 g,平均2771.9 g.术前诊断十二指肠梗阻,其中肠旋转不良合并肠扭转12例,环状胰腺28例,十二指肠膜式闭锁14例.结果 腹腔...     

26例先天性十二指肠梗阻的外科治疗

目的 探讨先天性十二指肠梗阻的病因、临床表现、手术方法及术后处理.方法 回顾性分析我院1993年10月至2010年10月期间治疗的26例先天性十二指肠梗阻患者的临床资料.结果 26例先天性十二指肠梗阻患者中肠旋转不良16例,行Ladd手术,其中1例因术中发现广泛肠坏死家属放弃治疗,其余15例痊愈.4例单纯十二指肠膈膜者行十二指肠膈膜切除术(纵切横缝),3例单纯十二指肠狭窄者行十二指肠空肠吻合术,均痊愈.单纯环状胰腺2例,行十二指肠-十二指肠菱形吻合术或十二指肠空肠吻合术后均痊愈.肠系膜上动脉压迫综合征1例,行十二指肠空肠吻合术后痊愈.结论 先天性十二指肠梗阻是常见的新生儿急症,早期诊断,正确处理不同类型梗阻,加强围手术期处理,是提高治愈率的关键.     

小儿先天性十二指肠梗阻(附23例临床分析)

本文报告23例小儿先天性十二指肠梗阻,将病理类型分为管腔内型及管腔外型,并指出引起十二指肠梗阻的病理畸形常相互并存。术中应仔细探查,以防遗漏使手术治疗失败。小儿生后顽固性胆汁样呕吐,是多数患儿的主要症状,上腹部胃及十二指肠蠕动波及X线腹部平片“双泡征”,对诊断有重要意义。     

先天性十二指肠梗阻61例临床分析

先天性十二指肠梗阻是常见的消化道畸形及新生儿急腹症,现分析总结我院收治６１例该病患者的有关资料。１．临床资料：１９９０年１月～２００２年５月共收治先天性十二指肠梗阻６１例,其中男４７例,女１４例。年龄１月内３５例,１～１２个月１３例,１～３岁２例,４～７岁２例,７岁以上９例（成人３例）。其中肠旋转不良４５例;十二指肠闭锁５例;十二指肠膈膜８例;单纯环状胰腺３例。５２例以呕吐为主要症状,其中４１例呕吐物含胆汁。X线检查１９例可见双泡征。４５例肠旋转不良患者中,３１例行Ladd术;１３例行Ladd术加其他…     

腹腔镜胆总管十二指肠吻合术治疗恶性梗阻性黄疸

目的:回顾分析腹腔镜胆总管十二指肠吻合术病人临床资料,探讨腹腔镜胆总管十二指肠吻合术在治疗恶性梗阻性黄疸中的应用。方法:总结本院2009年6月至2012年10月因恶性梗阻性黄疸行腹腔镜胆总管十二指肠吻合术96例病人的手术经验及其随访结果。结果:平均手术时间(103±43)(45～215)min,术中出血约20 mL。6例出现术后近期并发症,其中2例腹腔出血,予以手术止血,3例胆漏,另1例腹腔感染。术后平均住院(9±2)(3～14)d。术后随访4例出现远期并发症,其中2例十二指肠梗阻行胃肠吻合,另2例再次黄疸,分别予以ERCP和经皮肝穿刺引流。术后平均生存期为(7.6±2.8)(2～24)个月。结论:腹腔镜胆总管十二指肠吻合术安全可行,在恶性梗阻性黄疸的姑息性治疗中具有效果确切、创伤小、康复快、并发症少的优点。     

腹腔镜穿孔缝合术治疗急性胃十二指肠溃疡穿孔效果分析

目的分析腹腔镜穿孔缝合术治疗急性胃十二指肠溃疡穿孔的临床效果。方法对36例急性胃十二指肠溃疡穿孔患者实施腹腔镜穿孔缝合术治疗。患者恢复出院时,开始正规实施标准三联疗法进行抗溃疡及抗幽门螺杆菌治疗。回顾性分析患者的临床资料。结果 36例患者手术进程顺利,无中转开腹手术。术中出血量40~110 mL,平均50.20 mL。手术时间78~136 min,平均88.50 min。术后下床活动时间15~29 h,平均18.50 h。术后腹腔引流管无明显液体引出后均于72 h内拔除。术后住院时间4~6 d,平均5.12 d。患者术后均获随访1~2 a,术后12个月复查胃镜显示溃疡愈合良好。结论腹腔镜穿孔缝合术治疗急性胃十二指肠溃疡穿孔,创伤轻,术后恢复效果可靠、安全性高。但术中需排除胃癌穿孔,术后需规范进行抗溃疡及抗幽门螺杆菌治疗。     

外科治疗小儿先天性巨十二指肠症

目的:探讨小儿巨十二指肠症的诊断、发病机理及手术方式选择。方法:观察本症手术前后临床表现,术中术后病理改变及不同手术方式治疗效果。结果:胃空肠吻合加幽门离断术术后改善较轻;单纯胃空肠吻合术中度改善;十二指吻成形加胃空肠吻合术改善较好。结论:十二指肠成形、胃空肠吻合术疗效相对较好。     

Laparoscopic repair/peritoneal toilet of perforated duodenal ulcer

Summary Laparoscopic techniques have been refined to the point where exposure, haemostasis and tissue approximation by suture approach those obtained at open access surgery. We report a patient with acute perforation of an ulcer in the first part of the duodenum who was successfully treated by laparoscopic oversewing and omental patching. The clinical indications for contemplating use of laparoscopic surgery for acute ulcer perforation, techniques employed and the areas for potential improvement of instruments, needles and sutures are discussed.     

Laparoscopic ureteroureteral anastomosis for repair of ureteral injury involving stricture

We describe an approach to laparoscopic ureteroureteral anastomosis for surgical management of ureteral stricture, and review four cases in which this method was used. In these four cases, we observed no intraoperative complications. Patients length of hospital stay was 1–2 days. Follow-up ranged from 12 to 14 months. All four patients have been asymptomatic, and their follow-up intravenous pyelograms (IVPs) have been normal. This surgical approach warrants further study with larger series and long-term follow-up.Editorial Comment: As experienced laparoscopists advance their abilities to tackle difficult problems once only remedied by laparotomy, they need to be cognizant of a few points. The ability to help the patient and lessen suffering is paramount, and laparoscopy can accomplish this in the hands of experienced surgeons. The general rule of thumb—that principles of laparoscopic surgery need to mirror its laparotomy counterparts—is crucial. One cannot forget that when a proper retroperitoneal dissection is warranted, exposure and anatomical considerations, such as ureteral blood supply in the distant third of the ureter, need to be considered. The success of such a small series certainly raises the idea that a laparoscopic approach to fixing a ureteral injury is possible and beneficial if done appropriately and by experienced hands.     

生物可分解吻合环在肠梗阻行肠一期切除吻合术中的应用

为探讨生物可分解吻合环在急诊肠梗阻患者行一期切除吻合术中的应用价值，回顾分析2006-2010年使用生物可分解吻合环行一期切除吻合术的25例急诊肠梗阻患者资料。结果显示，全组术中吻合过程均顺利，无手术死亡，创口感染2例，无吻合口漏、吻合口狭窄发生。结果表明，应用生物可分解吻合环行肠梗阻手术可提高吻合成功率，减少并发症，且操作简单、安全、省时．是一种理想的方法。     

Use of Barbed Sutures in Laparoscopic Gastrointestinal Single-Layer Sutures

Methods:Between August 2012 and March 2014, 15-cm-long barbed sutures (V-Loc 180; Covidien, Mansfield, MA, USA) were used for laparoscopic intestinal anastomoses, including intestinal hole closure for esophagojejunal and gastrojejunal anastomoses after mechanical anastomoses and gastric wall closure after partial resection.Results:In total, 38 patients underwent 40 laparoscopic anastomoses (esophagojejunostomies, 26; gastrojejunostomies, 7; and simple closure of gastric defect, 7); no cases required conversion to open surgery. Two cases exhibited positive air leak test results during surgery (1 case of esophagojejunostomy and 1 case of simple closure of gastric defect). Two cases of intestinal obstruction were noted; of those, one patient with postoperative intestinal paresis (grade II) was managed conservatively, and the other underwent repeat laparoscopic surgery (grade IIIb) for internal herniation unrelated to V-Loc use. No postoperative complications at the anastomosis site and no surgery-related deaths were noted.Conclusion:Single-layer entire-thickness running suturing with the V-Loc 180 barbed suture after stapled side-to-side intestinal anastomosis was found to be safe and feasible in the reported cases.     

Randomized Controlled Trial of Barbed Polyglyconate Versus Polyglactin Suture for Robot-Assisted Laparoscopic Prostatectomy Anastomosis: Technique and Outcomes

Background

Transperitoneal robot-assisted laparoscopic prostatectomy (RALP) urethrovesical anastomosis is a critical step. Although the prevalence of urine leaks ranges from 4.5% to 7.5% at high-volume RALP centers, urine leaks prolong catheterization and may lead to ileus, peritonitis, and require intervention. Barbed polyglyconate sutures maintain running suture line tension and may be advantageous in RALP anastomosis for reducing this complication.

Objective

To compare barbed polyglyconate and polyglactin 910 (Vicryl, Ethicon, Somerville, NJ, USA) running sutures for RALP anastomosis.

Design, setting, and participants

This was a prospective, randomized, controlled, single-surgeon study comparing RALP anastomosis using either barbed polyglyconate (n = 45) or polyglactin 910 (n = 36) sutures.

Surgical procedure

RALP anastomosis using either barbed polyglyconate or polyglactin 910 sutures was studied.

Measurements

Operative time, cost differential, perioperative complications, and cystogram contrast extravasation by anastomosis suture type were measured.

Results and limitations

Although baseline characteristics and overall operative times were similar, barbed polyglyconate sutures were associated with shorter mean anastomosis times of 9.7 min versus 9.8 min (p = 0.014). In addition, anastomosis with barbed polyglyconate rather than polyglactin 910 sutures was associated with more frequent cystogram extravasation 8 d postoperatively (20.0% vs 2.8%; p = 0.019), longer mean catheterization times (11.1 d vs 8.3 d; p = 0.048), and greater suture costs per case ($51.52 vs $8.44; p < 0.001). After 8 of 29 (27.6%) barbed polyglyconate anastomosis sites demonstrated postoperative day 8 cystogram extravasation, we modified our technique to avoid overtightening, reducing cystogram extravasation to 1 (6.3%) of 16 subsequent barbed polyglyconate anastomosis sites. Potential limitations include small sample size and the single-surgeon study design.

Conclusions

Compared to traditional sutures, barbed polyglyconate is more costly and requires technical modification to avoid overtightening, delayed healing, and longer catheterization time following RALP.     

Single-Layer versus Double-Layer Laparoscopic Intracorporeally Sutured Gastrointestinal Anastomoses in the Canine Model

Objective:

The objective of this study was to compare the gross and histopathologic changes following 1- versus 2-layer hand-sewn suture techniques in laparoscopic gastrointestinal anastomosis in dogs.

Methods:

This was an experimental prospective study of 16 healthy mixed breed male and female dogs. Animals were randomly divided into 2 groups. Two-layer side-to-side hand-sewn laparoscopic gastrojejunostomies were performed in group A, so that simple interrupted sutures were placed in the outer layer and simple continuous suture was used in the inner layer. The 1-layer simple continuous anastomosis between the stomach and jejunum was done in group B precisely. Specimen were collected from the sites of anastomosis, and H&E statining was performed for light microscopic studies.

Results:

All animals survived the surgery. There was no gross inflammation, ischemia, apparent granulation tissue, abscess or fistula formation, leakage or stricture formation, and all sites of anastomosis were patent. Several adhesion formations were found in the abdomen with the higher incidence in the control group. Mean scores of leukocyte infiltration and granulation tissue formation at the sites of anastomosis were statistically insignificant between groups (P>0.05).

Conclusions:

Gross and histopathologic findings revealed that hand-sewn laparoscopic gastrointestinal anastomosis with the 1-layer suture technique is comparable to the 2-layer suture technique.     

完全腹腔镜Roux-en-Y吻合术治疗先天性胆总管囊肿

目的探讨完全腹腔镜下Roux-en-Y吻合术治疗先天性胆总管囊肿的可行性。方法 2011年3～9月,对6例先天性胆总管囊肿行完全腹腔镜下Roux-en-Y吻合术。术中常规切除胆囊,游离囊肿壁,于正常肝总管交界处离断。距十二指肠悬韧带15～20 cm处切断空肠,于断端远端下方约50 cm处用腔镜直线切割吻合器行肠肠吻合,镜下用3-0可吸收线行肝总管-空肠端侧吻合。结果手术均获成功。术后随访3～9个月,平均5.5月,无出血、胆漏、吻合口狭窄、肠漏、腹腔脓肿、逆行感染等并发症发生。结论完全腹腔镜Roux-en-Y吻合术治疗先天性胆总管囊肿是可行的,并且具有切口小、术后腹壁瘢痕小、创伤轻、美观等微创特点。