腹腔镜手术治疗新生儿肠旋转不良的并发症分析

目的: 总结腹腔镜手术治疗新生儿肠旋转不良的并发症及原因，探讨减少并发症的方法。方法: 回顾性分析2015年1月至2018年1月浙江大学医学院附属儿童医院新生儿外科采用腹腔镜手术治疗新生儿肠旋转不良的81例患儿的临床资料。分析术中情况、术后并发症和再次手术情况等。结果: 81例患儿均顺利完成腹腔镜手术，无中转开腹病例。10例患儿术中发现合并畸形，其中合并环状胰腺6例，合并十二指肠隔膜4例。术后发生肠扭转3例（3.7%），其中2例分别于术后1周和3个月时行开腹手术，术中证实肠扭转大部分中肠坏死，家属放弃治疗后死亡；1例于术后6个月因肠扭转再次行腹腔镜手术治疗，未再发肠扭转。术后发生盲肠穿孔1例（1.2%），术中电刀烧灼阑尾残端过程中阑尾根部结扎处可见气泡产生，可能与局部受热或电灼伤有关。术后发生乳糜腹1例（1.2%），经保守治疗后好转。术后发生粘连性肠梗阻3例（3.7%），经保守治疗后缓解。结论: 腹腔镜手术治疗新生儿肠旋转不良是切实可行的方法。腹腔镜操作技术的不断成熟以及围手术期管理的加强可有效减少并发症的发生。
Abstract: Objective: To analyze complications after laparoscopic Ladd operation for intestinal malrotation, related causes and possible solutions. Methods: Clinical data of 81 neonates who underwent laparoscopic Ladd operations for intestinal malrotation in the Children's Hospital, Zhejiang University School of Medicine between January 2015 and January 2018 were reviewed. The abdominal complications and findings during operation and reoperation were analyzed. Results: Operations were successfully completed in all patients, and there was no patient converted to open surgery. The annular pancreas in 6 cases and duodenal diaphragm in 4 cases were confirmed during the operation. The recurrent volvulus developed in 3 patients (3.7%), of whom 2 cases were confirmed to have midgut necrosis during open surgery 1 week and 3 months after laparoscopic Ladd operation, and both finally died; 1 case was corrected by second laparoscopic operation. Cecal perforation occurred in 1 patient (1.2%), which was caused by intensive high frequency coagulation of the appendiceal stump. One patient (1.2%) developed chylous ascites and improved after conservative treatment. Adhesive small bowel obstruction was observed in 3 cases (3.7%), and all relieved after conservative treatment. Conclusion: Laparoscopic Ladd operation for intestinal malrotation in neonates was effective, and the incidence of abdominal complications may be minimized by experienced skills and strict perioperative management. Key words: Laparoscopy Intestinal diseases/congenital Intestinal volvulus/surgery Intestinal volvulus/complications Intestinal perforation/complications Intestinal obstruction/complications