Fujimoto T, Segawa O, Lane G J, Esaki S, Miyano T
Department of Pediatric Surgery, Juntendo University, School of Medicine 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
Surg Endosc. 1999 Aug;13(8):773-7. doi: 10.1007/s004649901096.
Thanks to various technical innovations and advances in instrumentation, laparoscopic surgical intervention is now possible for certain congenital anomalies in children. To test the applicability of laparoscopic surgery in neonates, we reviewed our personal experience of neonatal laparoscopic surgery, focusing on cardiopulmonary function, surgical procedures, problems with devices, and degree of associated surgical stress.
We performed 65 laparoscopic procedures in neonates. Their ages ranged from 2 to 30 days old, and their body weights ranged from 1,980 to 4,780 g. All 65 laparoscopic procedures were carried out without mortality or serious morbidity.
As complications, we encountered four cases of hypothermia due to rapid insufflation of carbon dioxide (CO(2)). We also found that relative hypercapnea (increase in end-tidal CO(2) as high as 61 mmHg) developed unless hyperventilation and a relatively high peak insufflation pressure were maintained during pneumoperitoneum. No cardiac depression developed at this insufflation pressure. Fluid and electrolyte balance during our cases of newborn laparoscopic surgery, as well as the doses and volumes of fluid and electrolytes administered, were identical to those required for open surgery. Interleukin-6 (IL-6) was measured serially to estimate the degree of associated surgical stress and was found to be significantly lower in neonates who had received laparoscopic procedures than in those who had received open procedures.
Laparoscopic surgery can be carried out safely even in neonates.
由于各种技术创新和器械的进步，现在可以对儿童的某些先天性异常进行腹腔镜手术干预。为了测试腹腔镜手术在新生儿中的适用性，我们回顾了我们个人的新生儿腹腔镜手术经验，重点关注心肺功能、手术过程、器械问题以及相关手术应激程度。
我们对新生儿进行了65例腹腔镜手术。他们的年龄在2至30天之间，体重在1980至4780克之间。所有65例腹腔镜手术均未出现死亡或严重并发症。
作为并发症，我们遇到4例因快速注入二氧化碳（CO₂）导致的体温过低。我们还发现，除非在气腹期间维持过度通气和相对较高的峰值注入压力，否则会出现相对高碳酸血症（呼气末CO₂升高至61 mmHg）。在此注入压力下未出现心脏抑制。我们的新生儿腹腔镜手术病例中的液体和电解质平衡，以及所给予的液体和电解质的剂量和体积，与开放手术所需的相同。连续测量白细胞介素-6（IL-6）以评估相关手术应激程度，发现接受腹腔镜手术的新生儿的IL-6明显低于接受开放手术的新生儿。
即使在新生儿中，腹腔镜手术也可以安全进行。
