Li Bing, Chen Wei-Bing, Zhou Wen-Yan
Department of Pediatric Surgery, Huai'an Women and Children's Hospital , Jiang Su, China .
J Laparoendosc Adv Surg Tech A. 2013 Oct;23(10):881-4. doi: 10.1089/lap.2013.0097. Epub 2013 Aug 22.
To evaluate the feasibility of and indication for laparoscopic methods for neonates with congenital duodenal obstruction.
From September 2009 to October 2012, 40 newborns with duodenal obstruction underwent exploratory laparoscopy. With a lower-pressure pneumoperitoneum of 6-8 mm Hg and a suspending suture for the right liver elevator, the procedure was performed using four trocars 3-5 mm in diameter. Under laparoscopic vision, the causes of duodenal obstruction were diagnosed, and then the operation methods were determined by the type of obstruction.
Of the 40 cases, 4 were duodenal atresia (type II), 8 were duodenal stenosis, 8 were annular pancreas, and 20 were congenital intestinal malrotation. For the cases with duodenal diaphragmatic stenosis a partial excision of the diaphragm was performed after longitudinal incision of the anterior part of the duodenum followed laparoscopically by a transverse suture. For the cases with duodenal atresia (type II) and annular pancreas, a duodenal diamond anastomosis was successfully carried out through a laparoscopic approach. Ladd's operational method was performed in the cases with congenital intestinal malrotation. Feedings were started on postoperative Day 3-7, without abdominal distention and vomiting, and discharge from the the hospital was on postoperative Day 9-14.
Congenital duodenal obstruction is a common malformation in neonates. The laparoscopic procedure is an important method of diagnosing, and correct operational methods are the key to improve the therapeutic effect in the treatment of congenital duodenal obstruction. The laparoscope has the value of a small incision, microinvasion, and better recovery in diagnosis and treatment for congenital duodenal obstruction. The laparoscopic methods can be performed in neonates safely and are appropriate for a full-term newborn with tolerance to CO2 pneumoperitoneum.
评估腹腔镜手术治疗先天性十二指肠梗阻新生儿的可行性及适应证。
2009年9月至2012年10月，40例十二指肠梗阻新生儿接受了腹腔镜探查术。采用6 - 8毫米汞柱的低压气腹，并使用右肝上提悬吊缝线，通过4个直径3 - 5毫米的套管针进行手术。在腹腔镜视野下，诊断十二指肠梗阻的病因，然后根据梗阻类型确定手术方法。
40例中，十二指肠闭锁（Ⅱ型）4例，十二指肠狭窄8例，环状胰腺8例，先天性肠旋转不良20例。对于十二指肠隔膜狭窄病例，在十二指肠前部纵行切开后行隔膜部分切除，然后腹腔镜下横行缝合。对于十二指肠闭锁（Ⅱ型）和环状胰腺病例，成功通过腹腔镜方法进行了十二指肠菱形吻合术。对先天性肠旋转不良病例采用Ladd手术方法。术后3 - 7天开始喂养，无腹胀及呕吐，术后9 - 14天出院。
先天性十二指肠梗阻是新生儿常见的畸形。腹腔镜手术是诊断的重要方法，正确的手术方法是提高先天性十二指肠梗阻治疗效果的关键。腹腔镜在先天性十二指肠梗阻的诊断和治疗中具有切口小、微创及恢复较好的价值。腹腔镜手术方法可安全地应用于新生儿，适用于能耐受二氧化碳气腹的足月儿。
