Abhyankar A, Mukhtar Z
Consultant Pediatric Surgeon/Urologist, University Hospital of Wales, Cardiff, UK.
Asian J Endosc Surg. 2011 May;4(2):90-3. doi: 10.1111/j.1758-5910.2011.00075.x.
Neonatal intestinal atresia surgery requires careful assessment of bowel patency, resection of the affected bowel and a diligent anastomosis. Traditional anastomosis with sutures via a laparoscopic approach would lengthen the surgical time. Various minimally invasive techniques have been reported for neonatal surgery. Our technique offers improved benefits of laparoscopy while observing good principles of surgery.
Using a three-port approach to aid careful laparoscopic inspection of the bowel, we performed laparoscopy-assisted neonatal intestinal atresia repair in three term neonates with no cardiorespiratory compromise. Anastomosis was manually performed after exteriorzation of the bowel via the umbilical port site without any extension of the original port-site incision. There were no complications or conversions to open approach.
Our technique is an improvement over previously reported limited/umbilical laparotomy approaches and blends the benefits of laparoscopy and open surgery most effectively. Careful bowel inspection and assessment of patency could be safely and systematically performed laparoscopically with limited exteriorization of the bowel for rapid hand-sewn anastomosis and without compromising bowel viability. A multicenter randomized trial will be useful to compare the open laparotomy approach with our technique.
新生儿肠闭锁手术需要仔细评估肠管通畅情况、切除病变肠段并进行精细的吻合。传统的经腹腔镜途径用缝线进行吻合会延长手术时间。已有多种微创技术应用于新生儿手术。我们的技术在遵循良好手术原则的同时，提升了腹腔镜手术的优势。
采用三孔法辅助对肠管进行仔细的腹腔镜检查，我们对3例足月且无心肺功能障碍的新生儿实施了腹腔镜辅助下的新生儿肠闭锁修复术。通过脐部切口将肠管拖出后进行手工吻合，未延长原切口。无并发症发生，也未中转开腹手术。
我们的技术是对先前报道的有限/脐部剖腹手术方法的改进，最有效地融合了腹腔镜手术和开放手术的优势。通过腹腔镜可安全、系统地仔细检查肠管并评估通畅情况，有限地拖出肠管以便快速进行手工吻合，且不影响肠管活力。一项多中心随机试验将有助于比较开放剖腹手术方法与我们的技术。
