新生儿先天性肠旋转不良：腹腔镜 Ladd 手术与开腹手术比较。
Congenital Intestinal Malrotation in Newborns: Laparoscopic Ladd's Procedure versus Open Laparotomy.
机构信息
Department of Pediatric Surgery, Ganzhou Maternal and Child Health Care Hospital, Ganzhou Jiangxi, China.
出版信息
J Coll Physicians Surg Pak. 2023 Feb;33(2):222-226. doi: 10.29271/jcpsp.2023.02.222.
OBJECTIVE
To assess the efficacy and safety of laparotomic or laparoscopic Ladd's procedure in newborns with congenital malrotation.
STUDY DESIGN
Descriptive study.
PLACE AND DURATION OF STUDY
Department of Pediatric Surgery, Ganzhou Maternal and Child Health Care Hospital, Ganzhou JiangXi province, China, from January 2015 to December 2021.
METHODOLOGY
The clinical data of newborns with malcorrection were retrospectively analysed. Patients were divided into laparotomy group (64 cases) and laparoscopy group (30 cases), according to the surgery they had been subjected. The patients who had the severe malformations, underwent the laparoscopic Ladd's procedure at the first 10 cases, and had found bowel necrosis during operation were excluded. The general data such as lengths of operation, intraoperative blood loss, time-to-diet, lengths of hospital stay, and postoperative complications were compared between the two groups.
RESULTS
Crude comparisons showed that the laparoscopy increased the lengths of operative time (70.0 vs. 110.0 minutes, p <0.001) but decreased the postoperative complications (25.0% vs. 6.7%, p=0.035). The intraoperative blood loss, time-to-diet, and lengths of hospital stay between the two groups were not statistically significant (p=0.109, 0.065, and 0.858 respectively). The intestinal volvulus in the two groups (43.8% vs. 80.0%, p=0.001) had statistical differences. Using modified Poisson regression analysis, adjusting for confounding differences of midgut volvulus, lengths of operation time and intraoperative blood loss, and laparoscopic Ladd's showed a significant decrease in postoperative complications (RR=0.13,95%CI 0.03-0.54, p=0.005).
CONCLUSION
Laparoscopic Ladd's procedure is feasible to treat neonatal malrotation and is associated with lower postoperative complications of newborns with congenital malrotation.
KEY WORDS
Newborns, Congenital malrotation, Laparoscopy, Laparotomy, Complications.
目的
评估剖腹或腹腔镜下 Ladd 手术治疗先天性肠旋转不良新生儿的疗效和安全性。
研究设计
描述性研究。
地点和研究时间
中国江西省赣州市妇幼保健院小儿外科，2015 年 1 月至 2021 年 12 月。
方法
回顾性分析肠旋转不良新生儿的临床资料。根据手术方式，将患者分为剖腹组（64 例）和腹腔镜组（30 例）。排除严重畸形患者，前 10 例采用腹腔镜 Ladd 手术，术中发现肠坏死。比较两组患者的手术时间、术中出血量、进食时间、住院时间及术后并发症等一般资料。
结果
两组患者的手术时间比较，腹腔镜组明显延长（70.0 分钟比 110.0 分钟，p<0.001），术后并发症明显减少（25.0%比 6.7%，p=0.035）。两组患者术中出血量、进食时间及住院时间比较差异均无统计学意义（p=0.109、0.065、0.858）。两组肠旋转不良（43.8%比 80.0%，p=0.001）差异有统计学意义。采用修正泊松回归分析，调整中肠旋转不良、手术时间和术中出血量的混杂差异，腹腔镜 Ladd 手术与术后并发症减少显著相关（RR=0.13，95%CI 0.03-0.54，p=0.005）。
结论
腹腔镜 Ladd 手术治疗新生儿肠旋转不良是可行的，与先天性肠旋转不良新生儿术后并发症发生率较低有关。
关键词
新生儿；先天性肠旋转不良；腹腔镜；剖腹术；并发症。
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