新生儿及幼婴腹腔镜手术并发症的探讨

目的探讨新生儿及幼婴腹腔镜手术并发症的原因和处理。方法回顾性分析2003年1月～2007年6月287例新生儿及幼婴腹腔镜手术中发生10例并发症的临床资料。结果7例腹腔镜下幽门环肌切开术术中黏膜破裂中转开腹手术;趋附效应致迟发性幽门黏膜穿孔再手术1例;腹腔镜下Ladd’s术后肠梗阻存在,证实为肠旋转不良合并十二指肠狭窄（隔膜型）,再手术1例;以上9例开腹手术后均痊愈。腹腔镜下幽门环肌切开术术后戳孔疝1例,门诊随访4个月后自愈。结论新生儿及幼婴腹腔镜手术中,腹腔镜下幽门环肌切开术黏膜破损是最常见的并发症,须及时中转开腹;趋附效应可引起组织的延迟性损伤,应认识到这种病理改变的可能性,及早处理;肠旋转不良合并畸形率高,注意合并症的诊断和治疗。

Complications after Laparoscopic Surgeries in Newborn and Infant

Objective To explore the causes and treatment of the complications after laparoscopic surgery in neonate and infants. Methods From January 2003 to June 2007, totally 287 neonates and infants received laparoscopic surgeries in our hospital, 10 of them developed postoperative complications. Results The complications included 7 cases of gastric mucosa rupture during pyloric resection, 1 case of delayed rupture of the pylorus, 1 case of intestinal malrotation complicated with duodenal stenosis, and 1 case of incisional hernia. The former 9 cases were cured by open surgery, and the last one recovered spontaneously in 4 months. Conclusions Mucosarupture caused by pyloric resection is the most common complication after laparoscopic surgery in neonates and infants, open surgery should be performed in such a situation. Delayed rupture of the bowel after laparoscopic surgery can be potentially fatal, and should be treated as soon as possible. Intestinal malrotation may lead to a high rate of malformation, which can be avoided by early diagnosis and treatment.