腹腔镜治疗坏死性小肠结肠炎后结肠狭窄
Laparoscopic treatment of postnecrotizing enterocolitis colonic strictures.
作者信息
Martinez-Ferro Marcelo, Rothenberg Steven, St Peter Shawn, Bignon Horacio, Holcomb George
机构信息
Department of Pediatric Surgery, Fundación Hospitalaria, Hospital Privado de Niños, Buenos Aires, Argentina.
出版信息
J Laparoendosc Adv Surg Tech A. 2010 Jun;20(5):477-80. doi: 10.1089/lap.2009.0428.
The current report is a multicenter study of a series of infants who developed colonic strictures (CS) as a sequelae of necrotizing enterocolitis (NEC) and who were treated successfully with laparoscopic intestinal resection and primary anastomosis. During 2005-2008, 11 neonates (gestational ages, 32-38 weeks), with a mean birth weight of 1.7 kg (range, 0.96-2.2) and a mean weight at operation of 3.04 kg (range, 1.6-4.4 were approached laparoscopically, following the diagnosis of a post-NEC-CS. The two surgical techniques were: 1) laparoscopic mobilization with extracorporeal resection and anastomosis (LERA) in 4 (36%) and 2) laparoscopic mobilization with intracorporeal resection and anastomosis (LIRA) in 7 (64%) patients. Laparoscopy was effectively performed in all cases without conversion to open surgery. The median operative time was 93 minutes (range, 80-121). The anastomosis was colocolic in all patients, except in 1 case, in which it was colorectal. There were no operative complications. All babies recovered uneventfully and started oral feeding at a median time of 3.5 days (range, 1-11) postoperatively. Hospital discharge was at a median time of 9 days (range, 2-29) following operation. No recurrent strictures have developed.
本报告是一项多中心研究,涉及一系列因坏死性小肠结肠炎(NEC)后遗症而发生结肠狭窄(CS)并成功接受腹腔镜肠切除和一期吻合术治疗的婴儿。在2005年至2008年期间,11例新生儿(胎龄32 - 38周),平均出生体重1.7千克(范围0.96 - 2.2千克),手术时平均体重3.04千克(范围1.6 - 4.4千克),在诊断为NEC后CS后接受了腹腔镜手术。两种手术技术分别为:1)4例(36%)采用体外切除和吻合的腹腔镜游离术(LERA);2)7例(64%)采用体内切除和吻合的腹腔镜游离术(LIRA)。所有病例均成功实施腹腔镜手术,无一例转为开放手术。中位手术时间为93分钟(范围80 - 121分钟)。除1例为结直肠吻合外,所有患者均为结肠结肠吻合。无手术并发症。所有婴儿恢复顺利,术后中位3.5天(范围1 - 11天)开始经口喂养。术后中位9天(范围2 - 29天)出院。无复发性狭窄发生。