Blanco-Rodríguez G, Penchyna-Grub J, Trujillo-Ponce A, Silva-Aguirre E, Nava-Ocampo A A
Service of Thoracic Surgery and Endoscopy, Hospital Infantil de México Federico Gómez, México DF, México.
Eur J Pediatr Surg. 2006 Dec;16(6):438-42. doi: 10.1055/s-2006-924611.
We describe a new endoscopic procedure for membranectomy of fenestrated duodenal membranes.
With the patients under general anesthesia and tracheally intubated, a flexible video-panendoscope was introduced into the second portion of the duodenum. The fenestrated membrane was visualized and a triple-lumen stone extraction balloon of 15 mm was inserted through the fenestration. After the balloon was insufflated, gentle traction was performed in order to expose the fenestrated membrane and differentiate it from the normal duodenal wall. The orifice was dilated in order to introduce the endoscope and localize the Vater's ampulla. A sphincterotome was used to carry out one or two incisions of 1.5 to 2 cm in the membrane in the opposite direction to the ampulla.
The procedure was successfully performed in five patients with a mean surgical time of 50 minutes. None of the patients complained of postoperative pain. Peristalsis was not affected, and patients started intake of oral fluids at approximately 24 hours. On discharge patients were completely asymptomatic, and four patients were followed up for one year following the procedure and remained asymptomatic. One patient who was also asymptomatic did not continue follow-up longer than two weeks after the procedure.
Endoscopic membranectomy of duodenal membranes is a safe and effective procedure that reduces surgical times, postoperative fasting times and the length of hospitalization, and probably has no postoperative complications.
我们描述一种用于有孔十二指肠膜切除术的新内镜手术方法。
患者在全身麻醉并气管插管下，将可弯曲视频全景内镜插入十二指肠第二部。观察有孔膜，经穿孔插入一个15毫米的三腔取石球囊。球囊充气后，轻柔牵拉以暴露有孔膜并将其与正常十二指肠壁区分开来。扩张开口以便插入内镜并定位十二指肠乳头。使用括约肌切开刀在与壶腹相反方向的膜上进行1.5至2厘米的一或两个切口。
该手术在5例患者中成功实施，平均手术时间为50分钟。无患者诉术后疼痛。肠蠕动未受影响，患者约在术后24小时开始摄入流食。出院时患者完全无症状，4例患者术后随访1年仍无症状。1例无症状患者术后未继续随访超过2周。
十二指肠膜内镜切除术是一种安全有效的手术方法，可缩短手术时间、术后禁食时间和住院时间，且可能无术后并发症。
