Hill Sarah, Koontz Curt S, Langness Simone M, Wulkan Mark L
Division of Pediatric Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
J Laparoendosc Adv Surg Tech A. 2011 Dec;21(10):961-3. doi: 10.1089/lap.2011.0069.
BACKGROUND/PURPOSE: Congenital duodenal obstruction (CDO) is traditionally managed via laparotomy. Laparoscopy has been suggested as an alternative; however, few series have described this in neonatal CDO. We report our series of CDO repaired laparoscopically compared to laparotomy.
After Institutional Review Board approval, a retrospective review was performed on patients with CDO who were presented between October 2001 and July 2010. Duodenal obstruction was managed laparoscopically (LAP) or via an open approach (OPEN) based on the surgeon's choice. Data were analyzed by intention to treat and were expressed as median±range.
Twenty-two neonates underwent laparoscopy and 36 had a traditional laparotomy for management of CDO. Associated diseases included Down's syndrome (n=26), congenital heart disease (n=29), and malrotation (n=16). Median age was 4 days (range: 1-310) for LAP and 3 days (range: 0-166) for OPEN (P=.04). Gestational age and weight were similar (P=.335 and .378). The CDO was due to atresia (n=32), web (n=16), and annular pancreas (n=10). Median operative time for LAP was 116 minutes with a range of 73-164 while median time for OPEN was 103 minutes with a range of 71-220 (P=.013). There was no difference in time to full feedings (P=.69) or postoperative length of stay (P=.682). Ventilation time was 2 days with a range of 0-149 for LAP and ventilation time was 4 days with a range of 0-9 for OPEN (P=.02). Complication rates between the groups were similar.
In the hands of a skilled surgeon, laparoscopy appears to be a safe and effective technique in managing CDO in neonates. In this retrospective study, laparoscopic management of CDO appeared to allow a shorter postoperative ventilator requirement with similar length of stay and time to full feedings. Operative time was slightly longer in the LAP group. Formal prospective trials are recommended to validate these findings.
背景/目的：先天性十二指肠梗阻（CDO）传统上通过剖腹手术治疗。有人建议采用腹腔镜手术作为替代方法；然而，很少有系列报道新生儿CDO的腹腔镜手术治疗情况。我们报告了我们采用腹腔镜手术与剖腹手术治疗CDO的系列病例。
经机构审查委员会批准，对2001年10月至2010年7月期间就诊的CDO患者进行回顾性研究。根据外科医生的选择，采用腹腔镜手术（LAP）或开放手术（OPEN）治疗十二指肠梗阻。按意向性分析处理数据，数据表示为中位数±范围。
22例新生儿接受了腹腔镜手术，36例接受了传统剖腹手术治疗CDO。相关疾病包括唐氏综合征（n = 26）、先天性心脏病（n = 29）和肠旋转不良（n = 16）。LAP组的中位年龄为4天（范围：1 - 310天），OPEN组为3天（范围：0 - 166天）（P = 0.04）。胎龄和体重相似（P = 0.335和0.378）。CDO的病因包括闭锁（n = 32）、隔膜（n = 16）和环状胰腺（n = 10）。LAP组的中位手术时间为116分钟，范围为73 - 164分钟，而OPEN组的中位时间为103分钟，范围为71 - 220分钟（P = 0.013）。完全喂养时间（P = 0.69）或术后住院时间（P = 0.682）无差异。LAP组的通气时间为2天，范围为0 - 149天，OPEN组的通气时间为4天，范围为0 - 九天（P = 0.02）。两组间的并发症发生率相似。
在技术熟练的外科医生手中，腹腔镜手术似乎是治疗新生儿CDO的一种安全有效的技术。在这项回顾性研究中，CDO的腹腔镜手术治疗似乎术后呼吸机使用时间较短，住院时间和完全喂养时间相似。LAP组的手术时间略长。建议进行正式的前瞻性试验以验证这些发现。
