中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2010年
10期
728-731
,共4页
马丽霜%李龙%张悦%王莹%刘树立%马继东%张军%冯翠竹%李旭%李颀
馬麗霜%李龍%張悅%王瑩%劉樹立%馬繼東%張軍%馮翠竹%李旭%李頎
마려상%리룡%장열%왕형%류수립%마계동%장군%풍취죽%리욱%리기
腹腔镜外科手术%食管裂孔疝
腹腔鏡外科手術%食管裂孔疝
복강경외과수술%식관렬공산
Laparoscopic surgical procedures%Hiatal hernia
目的 探讨腹腔镜手术治疗婴幼儿食管裂孔疝的安全性和疗效.方法 2001年9月至2010年1月对34例婴幼儿食管裂孔疝患儿施行食管裂孔修补Nissen胃底折叠术.其中3例产前超声诊为"膈疝",术前造影1例合并肠旋转不良同时在腹腔镜下行Ladd's手术,1例合并胃排空延迟同时在腹腔镜下完成幽门成形术,1例合并右侧腹股沟斜疝同时在腹腔镜下完成疝囊高位结扎手术.结果 34例中1例中转开腹,其余33例均在腹腔镜下完成食管裂孔修补Nissen胃底折叠术.年龄最小2 h,手术时间平均122min(100～210min);术中出血量平均5ml(1～10ml);术后24～48 h进奶,术后住院4～12 d,平均6.5 d.26例术后随访1个月～6年,1例术后6 d出现呕吐,给予胃动力药物(吗丁啉)治疗后好转;2例患儿于术后1年及1年半复发,均再次行腹腔镜食管裂孔修补术治愈;其余生长发育正常,无明显并发症发生.结论 本研究证实了腹腔镜手术治疗婴幼儿食管裂孔疝具有明显优势,创伤小,疗效确切,可以联合治疗其他疾病,不会造成脏器粘连,对复发病例二次手术时仍可采用腹腔镜技术;即使食管旁疝和混合疝无症状也应早期手术.术者应具备新生儿手术经验及熟练的腔镜操作基础.
目的 探討腹腔鏡手術治療嬰幼兒食管裂孔疝的安全性和療效.方法 2001年9月至2010年1月對34例嬰幼兒食管裂孔疝患兒施行食管裂孔脩補Nissen胃底摺疊術.其中3例產前超聲診為"膈疝",術前造影1例閤併腸鏇轉不良同時在腹腔鏡下行Ladd's手術,1例閤併胃排空延遲同時在腹腔鏡下完成幽門成形術,1例閤併右側腹股溝斜疝同時在腹腔鏡下完成疝囊高位結扎手術.結果 34例中1例中轉開腹,其餘33例均在腹腔鏡下完成食管裂孔脩補Nissen胃底摺疊術.年齡最小2 h,手術時間平均122min(100～210min);術中齣血量平均5ml(1～10ml);術後24～48 h進奶,術後住院4～12 d,平均6.5 d.26例術後隨訪1箇月～6年,1例術後6 d齣現嘔吐,給予胃動力藥物(嗎丁啉)治療後好轉;2例患兒于術後1年及1年半複髮,均再次行腹腔鏡食管裂孔脩補術治愈;其餘生長髮育正常,無明顯併髮癥髮生.結論 本研究證實瞭腹腔鏡手術治療嬰幼兒食管裂孔疝具有明顯優勢,創傷小,療效確切,可以聯閤治療其他疾病,不會造成髒器粘連,對複髮病例二次手術時仍可採用腹腔鏡技術;即使食管徬疝和混閤疝無癥狀也應早期手術.術者應具備新生兒手術經驗及熟練的腔鏡操作基礎.
목적 탐토복강경수술치료영유인식관렬공산적안전성화료효.방법 2001년9월지2010년1월대34례영유인식관렬공산환인시행식관렬공수보Nissen위저절첩술.기중3례산전초성진위"격산",술전조영1례합병장선전불량동시재복강경하행Ladd's수술,1례합병위배공연지동시재복강경하완성유문성형술,1례합병우측복고구사산동시재복강경하완성산낭고위결찰수술.결과 34례중1례중전개복,기여33례균재복강경하완성식관렬공수보Nissen위저절첩술.년령최소2 h,수술시간평균122min(100～210min);술중출혈량평균5ml(1～10ml);술후24～48 h진내,술후주원4～12 d,평균6.5 d.26례술후수방1개월～6년,1례술후6 d출현구토,급여위동력약물(마정람)치료후호전;2례환인우술후1년급1년반복발,균재차행복강경식관렬공수보술치유;기여생장발육정상,무명현병발증발생.결론 본연구증실료복강경수술치료영유인식관렬공산구유명현우세,창상소,료효학절,가이연합치료기타질병,불회조성장기점련,대복발병례이차수술시잉가채용복강경기술;즉사식관방산화혼합산무증상야응조기수술.술자응구비신생인수술경험급숙련적강경조작기출.
Objective To investigate the safety and efficacy of the laparoscopic repair of hiatus hernia in infants. Methods Esophageal hiatus repair and Nissen fundoplication was performed in 34 infants with hiatal hernia during September 2001 to January 2010. Three cases were diagnosed as "diaphragmatic hernia "by prenatal ultrasonography at 27 weeks, 32 weeks, and 38 weeks gestational age,respectively. Their diagnoses were confirmed by gastrointestinal contrast radiography after birth. One of the three patients, whose gastrointestinal contrast radiography showed the signs of paraesophageal hernia, volvulus of stomach and gastroesophageal reflux, were performed laparoscopic repair 22 hours later after birth. Some patients underwent extra operations for other problems complicated with hiatus hernia: 1 patient underwent laparoscopic Ladds operation for intestinal malrotation; 1 underwent laparoscopic pyloroplasty for delayed gastric emptying; and 1 had laparoscopic hernia sac ligation for right inguinal hernia. Results The patients were successfully performed laparoscopic esophageal hiatus repair and Nissen fundoplication except 1 converted to open surgery. The youngest patient was only 2 hours after birth. The mean operation time was 122 min (100 min～210 min). The mean blood loss was 5ml (1～10 ml). Feeding started at 24～48 h after surgery. The average postoperative hospital stay was 6. 5 days (4～12days). Twenty six patients were followed up from 1 month to 6 years. One patient vomited in the 6th day after operation, and was improved after gastric motility medicine treatment (Domperidore). The recurrence of hiatus hernia was found in 2 patients at 1 and 1.5 years after operation, and cured after the second laparoscopic hiatus hernia repair. Conclusions Laparoscopic repair for infant hiatus hernia is safe and effective.
