腹腔镜治疗新生儿先天性十二指肠梗阻围术期管理

目的探讨腹腔镜治疗新生儿先天性十二指肠梗阻(CDO)的围术期管理方法。方法回顾性分析2002年7月-2011年4月28例CDO患儿腹腔镜手术的临床资料。男18例,女10例。肠旋转不良18例,十二指肠隔膜型狭窄6例,十二指肠闭锁、环状胰腺各2例。分别于术前、术中和术后针对不同患儿采取个体性规范化的管理措施,保证患儿的顺利治疗和恢复。结果 28例CDO患儿均顺利完成手术。其中Ladd手术18例,前壁纵行切开隔膜切除后横行缝合术6例,十二指肠菱形吻合术4例。28例均顺利出院,住院时间7～13 d。术后肠梗阻2例,新生儿寒冷损伤综合征1例,经治疗后均痊愈。随访2～68个月(31.3±4.8)个月],生长发育均正常。结论新生儿CDO经腹腔镜手术治疗是一种安全有效的方法,但需要有针对性地进行个体化的围术期管理,才能保证手术的安全实施。

Perioperative Management of Laparoscopic Operation for Neonatal Congenital Duodenal Obstruction

Objective To explore the perioperative management methods of laparoscopic operation in neonatal congenital duodenal obstruction(CDO). Methods The clinical data of 28 patients who were underwent the laparoscopic surgery for CDO were retrospectively analyzed from Jul.2002 to Apr.2011,18 male and 10 female.Eighteen cases with malrotation,6 cases with duodenal diaphragm stenosis,2 cases with duodenal atresia,2 cases with annular pancreas.Different normalized individual management in preoperative,intraoperative and postope-rative were adopted according to different cases to ensure the successfully laparoscopic operation. Results Twenty-eight cases were performed laparoscopic operation,including Ladd procedure in 18 cases,diaphragm resection and anastomosis in 6 cases and duodenal diamond-shaped anastomosis in 4 cases.Twenty-eight children were smooth discharged,length of hospital stay 7 to 13 d.Postoperative intestinal obstruction in 2 cases and neonatal cold injury syndrome in 1 case,who were all healed after effective treatment.All of 28 cases were verified normal growth and development with 2-68 months (31.3 ±4.8) months] follow-up. Conclusions Laparoscopic operation is a safe and effective method for the treatment of neonatal CDO.However,perioperative individual management is vital to successful laparoscopic operation.