新生儿肠旋转不良并中肠扭转的微创手术治疗

目的探讨腹腔镜下微创手术治疗新生儿先天性肠旋转不良并中肠扭转的方法及疗效。方法回顾性分析本院2012年1月至2015年10月经腹腔镜手术治疗的96例新生儿先天性肠旋转不良并中肠扭转患儿临床资料,其中男性65例,女性31例,入院年龄1~28 d,平均(11±8.2)d;体重1.9~4.2 kg,平均(3.1±0.5)kg。均以呕吐人院,出生后有胆汁性呕吐;6例有便血,无腹胀及腹膜炎体征。90例消化道造影检查显示十二指肠降部或水平部不全梗阻,其中74例空肠起始部位于脊柱右侧,6例便血患者未行消化道造影检查。96例彩色多普勒超声检查发现肠系膜血管呈漩涡症。结果 96例为肠旋转不良,92例合并中肠扭转,旋转360°~900°;6例术前有血便者存在肠系膜水肿,其中3例有乳糜腹,均无血运障碍。手术时间32~112 min,平均(59±18)min。1例肠系膜血管损伤,中转开腹止血,术中出血30 mL;2例结肠系膜撕裂行修补术;术后1~3 d进食。96例术后随访3~48个月,2例术后1个月出现呕吐,消化道造影检查显示十二指肠梗阻,再次手术发现为肠扭转并肠粘连,均在腹腔镜下再次完成手术。结论新生儿肠旋转不良并中肠扭转实为肠系膜顺时针方向旋转所致,腹腔镜下采用适当的复位方法能够缩短手术时间,降低手术难度,腹腔镜下手术治疗新生儿肠旋转不良并中肠扭转是安全有效的。

Minimally invasive surgery of congenital intestinal malrotation associated with midgut volvulus in neo-nates

Objetive To investigate the laparoscopic approach and therapeutic efficacy for congenital in-testinal malrotation associated with midgut volvulus in neonates. Methods Clinical data from 99 neonates with congenital intestinal malrotation associated with midgut volvulus between January 2012 and October 2015, was respectively analyzed.65 males and 31 females were enrolled in this study.Age ranged from 1 to 28 days (average age was 11 ±8.2 days)and weight ranged from 1.9 to 4.2 kg (average weight was 3.1 ±0.5 kg).Bilious vomiting was typical,but no abdominal distension and peritonitis symptoms were found in all patients, and hemafecia was noted 6 patients.Duodenal obstruction was revealed by upper gastrointestinal contrast in 90 patients,among them,Treitz ligament was found to locate on right side of spine in 74 cases.The mesenteric ves-sels presented votes sign under USG. Results Intestinal malrotation were diagnosed all patients and 92 cases of them was found to be associated with midgut volvulus from 360 to 900 degree.Mesenteric edema was found in 6 patients with hemafecia,in which 3 cases were associated with chyloperitoneum.Laparoscopic ladd’s proce-dure was engaged and operating time ranged from 32 to 112 minutes (Average time was 59 ±18 minutes).1case underwent conversion of open surgery due to mesenteric vascular injury.2 cases undertook mesenteric repair as the mesenteric tissue tear.Oral feeding was engaged in postoperative 1 ~3 days.All patients under-went follow up and follow up time ranged from 3 to 48 months.2 cases were found to vomit after surgery and duodenal obstruction was confirmed by upper gastrointestinal contrast,secondary laparoscopic surgery was done successfully and intestinal twist or adhesion during investigation. Conclusions The intestinal malrotation can be diagnosed and treated with laparoscopy.Patients could benefit from this minimally invasive approach with shorter operating period and reduced difficulty of performance,as well as ideal effectiveness.