小儿腹腔镜十二指肠缝合吻合术治疗先天性十二指肠梗阻

目的评价腹腔镜辅助十二指肠缝合吻合术治疗小儿先天性十二指肠梗阻的效果。方法2003年2月～2008年7月,采用腹腔镜十二指肠缝合吻合术治疗13例先天性十二指肠梗阻,年龄2天～12岁（新生儿7例,婴幼儿3例,少儿3例）。十二指肠闭锁或狭窄7例,环状胰腺2例,肠系膜上动脉综合征（superior mesenteric artery syndrome,SMAS）3例,十二指肠前门静脉1例。结果除1例十二指肠前门静脉在小切口辅助下进行十二指肠空肠吻合术外,5例十二指肠隔膜在腹腔镜下纵行切开其前壁切除隔膜后完成横行吻合术,2例十二指肠闭锁和2例环状胰腺成功在腹腔镜下行十二指肠菱形吻合术,3例SMAS在腹腔镜下行十二指肠空肠Roux-en-Y吻合术。手术时间（97.0±18.2）min（75～180min）,无手术并发症出现。术后2～5d开始进食,7～9d恢复正常饮食。出院前上消化道造影检查吻合口通畅。11例获随访6个月～4年,其中8例随访〉1年,生长发育良好。结论腹腔镜十二指肠缝合吻合术效果可靠,可以在新生儿期安全实施,为治疗先天性十二指肠梗阻提供了一个良好的微创手术方式。

Effectiveness of Laparoscopic Sutured Anastomosis of the Duodenum in Children

Objective To evaluate the effectiveness of laparoseopic sutured anastomosis of the duodenum for children with congenital duodenal obstruction （CDO）. Methods From February 2003 to July 2008, 13 patients （aged 2 days to 12 years） with CDO underwent laparoscopic sutured anastomosis of the duodenum in our hospital. Among the cases, 7 were newborns, 3 were infants, and 3 were children. Laparoscopy showed duodenal atresia or stenosis in 7 cases, annular pancreas in 2 cases, superior mesenteric artery syndrome （SMAS） in 3 cases, and preduodenal portal vein in 1 case. Results Excepting the patient with preduodenal portal vein,who was converted to mini-laparotomy for duodenojejunostomy, all the cases were treated by laparoseopy. In 5 cases, the diaphragm was excised partially after a vertical incision was made at the anterior part of the duodenum, and then a transverse suture was completed ; the 2 patients with duodenal atresia and the 2 with annular pancreas received diamond-shaped side-to-side duodenoduodenal anastomosis under a laparoseope; and the 3 cases of SMAS were treated by Roux-en-Y duodenojejunostomy. The mean operation time in this series was （97.0 ± 18.2） rain （range, 75 to 180 min）. No intraoperative complications occurred. The patients started oral intake in 2 to 5 days after the surgery, and resume a normal diet in 7 to 9 days. Before being discharged from the hospital, upper gastrointestinal tract imaging showed no evidence of obstruction in the patients. A follow-up up to 6 months to 4 years were available in 11 patients, among which 8 were followed for more than 1 year. During the period, the patient developed well. Conclusions The laparoscopie sutured anastomosis of the duodenum is feasible and effective for children. It can be performed in neonates securely as an excellent minimally invasive treatment for congenital duodenal obstruction.