经脐单孔腹腔镜手术治疗新生儿先天性肠闭锁和狭窄

目的总结经脐单孔腹腔镜手术治疗新生儿肠闭锁和狭窄的经验。方法回顾性分析2010年10月至2012年4月间在江苏淮安市妇幼保健院接受经脐单孔腹腔镜手术治疗的20例新生儿肠闭锁和狭窄的临床资料。结果20例新生患儿中男13例，女7例，入院时年龄出生后10min至3d，其中早产儿4例，低体质量儿（小于2500g）3例。经检查发现十二指肠闭锁1例，十二指肠狭窄1例．空肠闭锁9例．空肠狭窄2例，回肠闭锁7例。采用经脐单孔腹腔镜下进行探查．然后经稍扩大的脐孔将闭锁端肠管提致腹腔外进行吻合。20例患儿均用该方法完成手术．无中转开腹手术及常规腹腔镜手术。手术时间为35-60（平均40）min，术中出血量为出血3～5ml。2例患儿术后第2天家长放弃治疗，其余18例新生患儿术后5．10（平均7）d进流质饮食，10-20（平均13）d出院。术后随访1-11个月，1例死亡，3例因腹泻或营养不良行保守治疗好转，另14例患儿生长良好。结论经脐单孔腹腔镜治疗新生儿肠闭锁和狭窄操作简单，疗效满意。

Transumbilical laparoendoscopic single-site surgery in the treatment of neonatal intestinal atresia and stenosis

Objective To summarize the experiences and advantages of laparoendoscopic single-site （LESS） surgery for neonatal intestinal atresia and stenosis. Methods Twenty patients of neonatal intestinal atresia and stenosis were treated with LESS procedure in Huai＇an Women and Children＇s Hospital of Jiangsu Province between October 2010 and April 2012. The clinical data were retrospectively analyzed. Results Among these patients, 13 were male,7 were female. Age at admission ranged from 10 rain to 1 d. Four cases were premature, and 3 were born with low birth weight （〈2500 g）. One was diagnosed with duodenal atresia, 1 with duodenal stenosis, 9 with jejunal atresia, 2 with jejunal stenosis, and 7 with ileal atresia. Laparoscopic exploration was performed in all the cases by transnmbilical procedure, the proximal and distal ends were exteriorized from the umbilical port site for anastomosis. Twenty neonates with intestinal atresia and stenosis were performed using this new minimally invasive approach, with no cases converted to open operation or standard laparoscopy. The operative time was 35-60 （mean, 40 ） rain. The intraoperative bleeding was 3-5 ml. Two cases were given up treatment by their parents on the second postoperative day. For the other 18 patients, oral intake started on postoperative day 5-10 （mean, 7）, and discharged from hospital on the postoperative day 10-20 （mean, 13）. The follow up ranged from 1 to 11 months, during which 1 case died, 3 cases were managed with conservative treatment for diarrhea or malnutrition. The other 14 cases grew up healthily. Conclusion The technique of LESS in the treatment of neonatal atresia and stenosis is simple and the outcomes are satisfacto~.