Slater Bethany, Rangel Shawn, Ramamoorthy Chandra, Abrajano Claire, Albanese Craig T
Department of Surgery, Division of Pediatric Surgery, Stanford University Medical Center, Lucile Packard Children's Hospital, Stanford, CA, USA.
J Pediatr Surg. 2007 Jun;42(6):1118-21. doi: 10.1016/j.jpedsurg.2007.01.049.
BACKGROUND/PURPOSE: Laparoscopy has advanced the care of children for a variety of pediatric surgical diseases. However, complication rates for laparoscopic interventions in neonates with hypoplastic left heart syndrome (HLHS) have not been well described. The purpose of this study is to present the largest reported series of laparoscopic surgery performed in patients with HLHS.
We conducted a single-institution, retrospective chart review for all neonates with HLHS who underwent a laparoscopic procedure from September 2002 to March 2005. Data regarding patient characteristics, intraoperative monitoring, previous cardiac surgery, perioperative complications, and postoperative mortality were assessed.
Twelve patients with HLHS underwent a total of 13 operations during the study period (8 combined Nissen fundoplication and gastrostomy tubes, 3 isolated gastrostomy tubes, 1 Ladd procedure, and 1 combined Nissen fundoplication and gastrocutaneous fistula closure). All cases were completed laparoscopically. Patients had undergone palliative cardiac surgery but were not completely corrected; therefore, they were cyanotic. Perioperative complications were observed in 6 patients (3 gastrostomy tube site infections, 1 small bowel obstruction, 1 postoperative sepsis, and 1 urinary tract infection). There was no mortality in this series.
From this experience, it appears that laparoscopy can be performed safely and with satisfactory outcomes in patients with HLHS. However, a multidisciplinary approach, including the availability of a skilled and experienced cardiac anesthesia team, is believed to be critical to optimize outcomes in these critically ill children.
背景/目的：腹腔镜技术已推动了多种小儿外科疾病的患儿护理工作。然而，对于左心发育不全综合征（HLHS）新生儿进行腹腔镜干预的并发症发生率尚未得到充分描述。本研究的目的是呈现已报道的接受HLHS手术的最大腹腔镜手术系列病例。
我们对2002年9月至2005年3月期间接受腹腔镜手术的所有HLHS新生儿进行了单机构回顾性病历审查。评估了有关患者特征、术中监测、既往心脏手术、围手术期并发症及术后死亡率的数据。
在研究期间，12例HLHS患者共接受了13次手术（8例同时行Nissen胃底折叠术和胃造瘘管置入术，3例单纯胃造瘘管置入术，1例Ladd手术，1例同时行Nissen胃底折叠术和胃皮肤瘘关闭术）。所有病例均通过腹腔镜完成。患者已接受姑息性心脏手术但未完全矫正；因此，他们存在紫绀。6例患者出现围手术期并发症（3例胃造瘘管部位感染，1例小肠梗阻，1例术后败血症，1例尿路感染）。本系列病例无死亡情况。
从这一经验来看，似乎腹腔镜手术在HLHS患者中可以安全进行且效果令人满意。然而，包括配备熟练且经验丰富的心脏麻醉团队在内的多学科方法，被认为对于优化这些危重症患儿病情转归至关重要。
