CAJ | 학술논문

目的：探讨腹腔镜辅助治疗小儿肠闭锁或狭窄的疗效及安全性。方法回顾性分析2009年9月至2013年9月间在江苏省淮安市妇女儿童医院小儿外科接受腹腔镜辅助治疗的55例小肠闭锁或狭窄患儿的临床资料。12例十二指肠闭锁或狭窄患儿中，2例盲端型闭锁者在腹腔镜下行十二指肠菱形吻合术；1例十二指肠狭窄合并环状胰腺者则将脐孔切口扩大至3 cm后完成十二指肠菱形吻合手术；2例十二指肠狭窄者同时行Ladd手术；1例合并梅克尔憩室者同时经脐孔行梅克尔憩室切除吻合术。43例空回肠闭锁或狭窄患儿中，4例远端小肠闭锁者同时切除病变肠管；2例合并肠旋转不良者同时经脐孔切口行Ladd手术；2例行梅克尔憩室切除吻合术；15例行扩张肠管修剪吻合术。结果55例患儿均在腹腔镜辅助下完成手术。12例十二指肠闭锁或狭窄患儿的手术时间为80～145（平均110） min，术中出血5~15 ml，随访3~34（平均15.4）月，其中1例十二指肠闭锁患儿因术后吻合口上端巨型十二指肠扩张导致反复呕吐，家长放弃治疗死亡。43例空回肠闭锁或狭窄患儿的手术时间为35～70（平均46） min，均无术中需要输血和中转开腹手术者，随访3~36（平均16.7）月，3例合并胎粪性腹膜炎的空肠闭锁患儿术后出现短肠综合征，家长放弃治疗而死亡；还有1例术后3个月死于肠穿孔，1例术后7个月死于粘连性肠梗阻；4例出现粘连性肠梗阻，其中2例行再次手术治疗获愈。全组其余患儿术后恢复佳，生长发育良好。结论腹腔镜手术治疗小儿肠闭锁或狭窄安全有效。
목적：탐토복강경보조치료소인장폐쇄혹협착적료효급안전성。방법회고성분석2009년9월지2013년9월간재강소성회안시부녀인동의원소인외과접수복강경보조치료적55례소장폐쇄혹협착환인적림상자료。12례십이지장폐쇄혹협착환인중，2례맹단형폐쇄자재복강경하행십이지장릉형문합술；1례십이지장협착합병배상이선자칙장제공절구확대지3 cm후완성십이지장릉형문합수술；2례십이지장협착자동시행Ladd수술；1례합병매극이게실자동시경제공행매극이게실절제문합술。43례공회장폐쇄혹협착환인중，4례원단소장폐쇄자동시절제병변장관；2례합병장선전불량자동시경제공절구행Ladd수술；2례행매극이게실절제문합술；15례행확장장관수전문합술。결과55례환인균재복강경보조하완성수술。12례십이지장폐쇄혹협착환인적수술시간위80～145（평균110） min，술중출혈5~15 ml，수방3~34（평균15.4）월，기중1례십이지장폐쇄환인인술후문합구상단거형십이지장확장도치반복구토，가장방기치료사망。43례공회장폐쇄혹협착환인적수술시간위35～70（평균46） min，균무술중수요수혈화중전개복수술자，수방3~36（평균16.7）월，3례합병태분성복막염적공장폐쇄환인술후출현단장종합정，가장방기치료이사망；환유1례술후3개월사우장천공，1례술후7개월사우점련성장경조；4례출현점련성장경조，기중2례행재차수술치료획유。전조기여환인술후회복가，생장발육량호。결론복강경수술치료소인장폐쇄혹협착안전유효。
Objective To investigate the feasibility and efficacy of laparoscopic procedure in the diagnosis and treatment of congenital intestinal atresia and stenosis in neonates and infants. Methods Between September 2009 and September 2013, 55 cases with intestinal atresia and stenosis underwent laparoscope-assisted procedures in our department. There were, 32 males and 23 females, Twelve cases were diagnosed as duodenal atresia and stenosis and 43 as intestinal atresia and stenosis. The age at hospitalization was 7 minutes to 7 months (mean 9.88 d). After the diagnosis by multiport or transumbilical single-site laparoscopic exploration , cases with duodenal atresia and stenosis and part of the cases with proximal jejunum were treated by laparoscopic operations to remove the septum and restore intestinal continuity. In other cases with intestinal atresia and stenosis, laparoscopic inspection was performed to make diagnosis and then the proximal and distal ends of the atresia were exteriorized through the umbilical port site for end-to-oblique anastomosis. Results All the 55 cases underwent this minimally invasive approach, and no case was converted to open surgery. The operative time of laparoscopic procedure for duodenal atresia and stenosis (n=12) ranged from 80 to 145 min (mean, 110 min). During the follow-up of 3-34 months, one case had recurrent postoperative vomiting induced by giant duodenal expansion above anastomotic stoma and died the second day after operation. The operative time of laparoscopic surgery for intestinal atresia and stenosis (n=43) ranged from 35 to 70 min (mean 46 min). During the follow-up of 3-36 months, 3 cases complicated with meconium peritonitis had postoperative short bowel syndrome and died. One case died of intestinal perforation at 3 month postoperatively. One case died of intestinal adhesion at 7 month postoperatively. The rest of cases had favorable outcomes. Conclusion Laparoscopic surgery for the diagnosis and treatment of intestinal atresia and stenosis has advantages of small incision, less trauma, and rapid recovery.