Spilde Troy L, St Peter Shawn D, Keckler Scott J, Holcomb George W, Snyder Charles L, Ostlie Daniel J
Department of Pediatric Surgery, The Children's Mercy Hospital, Kansas City, MO 64108, USA.
J Pediatr Surg. 2008 Jun;43(6):1002-5. doi: 10.1016/j.jpedsurg.2008.02.021.
The advantages of using laparoscopy for repair of congenital duodenal obstructions (CDO) are unclear because of scant data about complications and outcomes. Nitinol U-clips (Medtronic Surgical, Minneapolis, Minn) were developed to assist in the creation of vascular anastomoses in small vessels. Because of their ability to approximate tissue tightly with little tissue damage, we have begun to use these U-clips for laparoscopic repair of CDO. In this report, we investigate the impact of laparoscopic U-clip repair of CDO compared to the traditional open repair.
With institutional review board approval, a retrospective analysis of all patients undergoing repair of CDO from January 2003 to July 2007 was performed. During this study period, patients who underwent open repair of CDO (group 1) were compared with patients that underwent laparoscopic repair using the U-clip technique (group 2).
Twenty-nine patients underwent repair of CDO. Fourteen patients (11 atresia, 3 stenosis) were in group 1 and 15 patients (11 atresia, 4 stenosis) in group 2. A female sex bias existed in group 1 (female-male [9:5]) compared to group 2 (female-male [7:8]). There was no difference in birth weight, age at operation, chromosomal anomalies, or congenital heart disease between the groups. There were no duodenal anastomotic leaks in either group. Operative times were similar between groups (96 vs 126 minutes; P = .06). The length of postoperative hospitalization (20.1 vs 12.9 days; P = .01), time to initial feeding (11.3 vs 5.4 days; P = .002), and time to full oral intake (16.9 vs 9 days; P = .007) were all statistically shorter in group 2.
The laparoscopic approach to CDO repair using U-clips is safe and efficacious. In addition, patients undergoing laparoscopic repair of CDO had a shorter length of hospitalization and more rapid advancement to full feeding compared to babies undergoing the open approach. We feel that in the hands of experienced laparoscopic surgeons, the preferred technique for correction of CDO will become the laparoscopic U-clip repair.
由于关于并发症和治疗结果的数据较少，使用腹腔镜修复先天性十二指肠梗阻（CDO）的优势尚不清楚。镍钛合金U形夹（美敦力外科公司，明尼阿波利斯，明尼苏达州）被开发用于辅助小血管的血管吻合。由于它们能够在几乎不造成组织损伤的情况下紧密贴合组织，我们已开始将这些U形夹用于CDO的腹腔镜修复。在本报告中，我们研究了CDO的腹腔镜U形夹修复与传统开放修复相比的效果。
经机构审查委员会批准，对2003年1月至2007年7月期间所有接受CDO修复的患者进行回顾性分析。在本研究期间，将接受CDO开放修复的患者（第1组）与采用U形夹技术进行腹腔镜修复的患者（第2组）进行比较。
29例患者接受了CDO修复。第1组有14例患者（11例闭锁，3例狭窄），第2组有15例患者（11例闭锁，4例狭窄）。与第2组（女∶男[7∶8]）相比，第1组存在女性性别偏向（女∶男[9∶5]）。两组之间的出生体重、手术年龄、染色体异常或先天性心脏病方面无差异。两组均未发生十二指肠吻合口漏。两组的手术时间相似（96分钟对126分钟；P = 0.06）。第2组的术后住院时间（20.1天对12.9天；P = 0.01）、开始进食时间（11.3天对5.4天；P = 0.002）和完全经口进食时间（16.9天对9天；P = 0.007）在统计学上均明显更短。
使用U形夹的CDO腹腔镜修复方法安全有效。此外，与接受开放手术的婴儿相比，接受CDO腹腔镜修复的患者住院时间更短，更快实现完全经口喂养。我们认为，在经验丰富的腹腔镜外科医生手中，CDO矫正的首选技术将成为腹腔镜U形夹修复。
