摘要： 目的·探讨腹腔镜在新生儿高位空肠闭锁/狭窄疾病中的治疗效果。方法·回顾分析2009年1月—2019年12月于山西省儿童医院经手术治疗的90例新生儿高位空肠闭锁/狭窄（距屈氏韧带30 cm以内）的病例资料。根据是否采用腹腔镜手术将患儿分为腹腔镜组（
n=66）和开腹组（
n=24）。腹腔镜组中，27例距屈氏韧带10 cm以内的Ⅰ型闭锁/狭窄在腹腔镜下吻合完成手术，39例距屈氏韧带10~30 cm的闭锁/狭窄行单部位腹腔镜辅助下扩大戳孔提出体外手术。开腹组患儿均采用传统开腹手术治疗。对比2组患儿手术时间、术后开始经口喂养时间、术后全量经口喂养时间［喂养量达150 mL/（kg·d）］、住院天数、病死率及术后并发症发生率的差异。结果·2组患儿在性别、年龄、体质量、早产、低出生体质量、合并其他系统畸形、病理类型等一般资料间差异均无统计学意义。腹腔镜组手术时间（77.0±24.0）min与开腹组（82.0±24.0）min间差异无统计学意义。腹腔镜组术后开始经口喂养时间、术后全量经口喂养时间和住院天数［（13.3±7.2）d、（19.1±8.1）d和（22.1±8.5）d］均较开腹组［（17.2±7.8）d，（23.7±10.6）d和（27.0±11.8）d］短（均
P<0.05）。腹腔镜组与开腹组在病死率（1/66
vs 2/24）及术后并发症发生率（7/66
vs 6/24）的差异均无统计学意义。结论·在新生儿高位空肠闭锁/狭窄诊治中，腹腔镜手术是一种安全、有效的方法。
关键词: 腹腔镜, 空肠闭锁, 新生儿 Abstract: Objective·To investigate the effect of laparoscope on the treatment of high jejunal atresia and stenosis in neonates.
Methods·From January 2009 to December 2019, 90 neonates with high jejunal atresia and stenosis were operated on Children′s Hospital of Shanxi province. According to whether laparoscopic surgery was used or not, they were divided into laparoscopic group (n=66) and laparotomy group (n=24). In the laparoscopic group, 27 cases of type Ⅰ atresia and stenosis less than 10 cm from Treitz ligament were anastomosed under laparoscopy, and 39 cases of jejunal atresia and stenosis 10?30 cm from the Treitz ligament, underwent extraperitoneal anastomosis by expanded trocar hole with the aid of single-site laparoscope. Traditional laparotomy exploratory incision was used in the laparotomy group. The operation time, the first postoperative oral feeding time, postoperative full oral feeding time [postoperative oral feeding volume reaching 150 mL/(kg·d)], the length of hospital stay, and mortality and incidence of complications were compared between the two groups.
Results·There was no significant difference between the laparoscopic group and laparotomy group in age, gender, weight, premature infant, low birth weight, other systems malformation and pathological type. There was no significant difference in operation time between the laparoscopic group and laparotomy group [(77.0±24.0) min vs (82.0±24.0) min]. The first postoperative oral feeding time, postoperative full oral feeding time [postoperative oral feeding volume reaching 150 mL/(kg·d)], and the length of hospital stay in the laparoscopic group were shorter than those in the laparotomy group [(13.3±7.2) d, (19.1±8.1) d, (22.1±8.5) d vs (17.2±7.8) d,(23.7±10.6) d, (27.0±11.8) d, all P <0.05]. There was no significant difference between the laparoscopic group and laparotomy group in mortality (1/66 vs 2/24) and incidence of complications (7/66 vs 6/24).
Conclusion·Laparoscopic surgery is a safe and effective method in the diagnosis and treatment of neonatal high jejunal atresia/stenosis.
Key words: laparoscope, jejunal atresia, neonate PDF全文下载地址:
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