Riquelme M, Aranda A, Riquelme-Q M, Rodriquez C
Department of Pediatric Surgery, Christus Muguerza Hospital Alta Especialidad, Monterrey, Mexico.
Eur J Pediatr Surg. 2008 Oct;18(5):334-6. doi: 10.1055/s-2008-1038532. Epub 2008 Oct 14.
There are few reports in the literature on the use of a laparoscopic approach for duodenal obstruction, particularly for duodenal atresia. We report here the results of 4 cases treated laparoscopically, and discuss the safety, feasibility and long-term results of this approach.
Four pediatric patients presented with duodenal obstruction, one with duodenal atresia, one with annular pancreas, and two with duodenal obstruction due to Ladd's bands but without malrotation. Diagnosis was made by clinical evaluation, simple X-ray film in the Ladd's patients, and contrast gastroduodenal X-ray series for the annular pancreas. All procedures were performed using 3-mm instruments and 3 trocars. Two duodeno-duodenal anastomoses were performed and two lyses of Ladd's bands; all procedures were carried out laparoscopically.
An upper GI contrast excluded obstruction or leakage in all patients 5 - 7 days after surgery and feedings were started. The patient with annular pancreas died of cardiovascular complications after one months. The other 3 patients are asymptomatic and tolerating feedings after a follow-up of 36 months.
We conclude that a laparoscopic approach for duodenal obstruction can be performed safely and effectively and achieves a short hospital stay. Laparoscopic lysis of Ladd's bands is easy to perform, but duodenoduodenostomy requires advanced laparoscopic skills.
文献中关于采用腹腔镜方法治疗十二指肠梗阻，尤其是十二指肠闭锁的报道较少。我们在此报告4例采用腹腔镜治疗的结果，并讨论该方法的安全性、可行性及长期疗效。
4例儿科患者表现为十二指肠梗阻，其中1例为十二指肠闭锁，1例为环状胰腺，2例因Ladd束带导致十二指肠梗阻但无肠旋转不良。通过临床评估、Ladd束带患者的简单X线片以及环状胰腺患者的胃十二指肠造影X线系列检查进行诊断。所有手术均使用3毫米器械和3个套管针。进行了2例十二指肠-十二指肠吻合术和2例Ladd束带松解术；所有手术均通过腹腔镜完成。
术后5 - 7天，上消化道造影排除了所有患者的梗阻或渗漏，随后开始喂养。环状胰腺患者术后1个月死于心血管并发症。其他3例患者在36个月的随访后无症状且能耐受喂养。
我们得出结论，腹腔镜治疗十二指肠梗阻安全有效，且住院时间短。腹腔镜下松解Ladd束带操作简便，但十二指肠-十二指肠吻合术需要先进的腹腔镜技术。
