新生儿十二指肠梗阻腹腔镜手术围术期并发症探讨

目的：探讨新生儿十二指肠梗阻腹腔镜手术围术期并发症的特点，并分析其产生原因和应对方法。方法总结分析本中心2012年1月至2016年5月经腹腔镜手术治疗的81例先天性十二指肠梗阻患儿临床资料。男性48例，女性33例；其中早产儿45例（孕周32～37 w）；低体重儿30例（体重＜2500 g，最小体重1304 g）。包括肠旋转不良35例，环状胰腺24例，十二指肠隔膜11例，十二指肠闭锁5例，多发畸形6例（环状胰腺伴隔膜1例，环状胰腺伴旋转不良4例，2处隔膜1例）。结果全组患儿除2例肠旋转不良中转开腹手术外，其余79例均完成腹腔镜手术；环状胰腺术后吻合口漏1例，经禁食、胃肠减压和支持治疗2周后痊愈；肠旋转不良手术后肠扭转、肠坏死1例，予再次开腹手术；旋转不良结肠电灼伤穿孔1例，予再次开腹手术修补；环状胰腺术后戳孔大网膜疝出1例，予再手术回纳。结论腹腔镜手术治疗新生儿十二指肠梗阻虽然较开放手术有优势，但同时也要注意其相关并发症。注意防范，不断提高手术技能，注重细节，扬长避短，尽可能减少并发症的发生。

Perioperative complications of laparoscopy for neonatal duodenal obstruction

Objetive To explore the perioperative complications of laparoscopy for congenital duodenal obstruction (CDO). Methods The clinical data of 81 CDO neonates undergoing laparoscopy from January 201 2 to May 201 6 were retrospectively analyzed.There were 48 males and 33 females,including 45 preterms (gestational age of 32 ~37 weeks)and 30 low-birth-weight infants (BW <2 500 g).Duodenal obstructions contained malrotation (n =35),annular pancreas (n =24),duodenal web (n =1 1 ),duodenal atresia (n =5)and multi-malformations (n =6). Results Laparoscopic procedures were completed in 79 cases except for 2 malrotating cases converting into open.One case of annular pancreas with anastomotic leakage spontaneously healed 2 weeks later through conservative measures of fasting and drainage.Intestinal volvulus necrosis oc-curred after laproscopic Ladd’s procedure (n =1 ),delayed bowel perforation due to electric injury during la-proscopic Ladd’s procedure (n =1 )and incision dehiscence (n =1 )with omental henia required open re-op-eration. Conclusions As a complicated and high-risk procedure,laparoscopy for neonatal CDO should be per-formed by skilled laparoscopic surgeon.Its complications may be reduced or even eliminated with more atten-tion and skill.