腹腔镜诊治新生儿十二指肠梗阻 34 例临床分析简

目的：探讨腹腔镜诊治新生儿十二指肠梗阻（CDO）的疗效，总结经验教训。方法：回顾性分析34例经腹腔镜诊断手术的CDO患儿的临床资料。结果：34例患儿中20例肠旋转不良，1例因术中肠管损伤中转进腹，19例完成腹腔镜Ladd术；环状胰腺10例施行腹腔镜十二指肠侧侧菱形吻合术；4例十二指肠隔膜样狭窄予纵形切开肠壁，切除部分隔膜后横行缝合肠管。手术时间90＆#177;23.2min（45-210min），术后3-5天进食，1例环状胰腺出现吻合口漏，经引流和静脉营养等治疗后痊愈。术后获得随访29例，随访3-18个月，1例肠旋转不良术后2个月出现粘连性肠梗阻，予对症治疗后自愈，所有患儿生长发育正常。结论：腹腔镜诊治CDO具有创伤小、恢复快、切口美观等优点，值得推广，但初期实施要注意避免手术并发症。

Clinical analysis of laparoscopic diagnosis and treatment of neonatal duodenal obstruction of 34 cases

Objective：To evaluate the curative effect of laparoscopic approach for the diagnosis and treatment of neonates with congenital duodenal obstruction （CDO） and to summarize the experience and lessons. Methods：The clinical data of 34 cases with CDO who underwent laparoscopic surgery were analyzed retrospectively from October 2011 to March 2013. Under the laparoscopic vision, the cause of CDO was explored and the CDO was treated propor-tionally according to corresponding pathological types. Results：20 cases with intestinal malrotation underwent laparo-scopic Ladd＆#39;s procedure except for 1 case with intraoperative bowel injury who was changed to laparotomy. A dia-mond-shaped side-to-side laparoscopic duodenoduodenal anastomosis was completed in 10 cases of annular pan-creas. 4 cases with duodenal diaphragmatic stenosis underwent a partial excision of the diaphragma after vertical in-cision of the anterior part in the duodenum followed by a transverse suture. The average operative time was 90 ＆#177; 23.2min （45~210min）. The patients started oral intake in 3~5 days after the surgery. 1 case of annular pancreas oc-curred anastomotic leak, who was cured by drainage and parenteral nutrition. 29 cases were followed up for 3~18 months after operation. 1 case of intestinal malrotation with symptom of ileus after surgery in 2 months was cured by symptomatic treatment. All children had normal growth and development. Conclusions：Laparoscopic operation has advantages of minimally invasive approach, quicker recovery and a better appearance for the diagnosis and treatment of neonates with CDO. Therefore, it can be applied widely. The initial implementation should be taken to avoid opera-tion complications.