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浙江大学学报（医学版）
浙江大学学报（医学版）  2018, Vol. 47 Issue (3): 261-265    DOI: 10.3785/j.issn.1008-9292.2018.06.07
专题报道     
经脐单部位腹腔镜手术治疗新生儿先天性十二指肠梗阻的疗效和安全性观察
吕成杰1(),胡东来2,黄寿奖1,秦琪1,赵晓霞1,胡书奇1,张雅楠2,方旋2,郭晓东2,钭金法1,*()
1. 浙江大学医学院附属儿童医院新生儿外科, 浙江 杭州 310052
2. 浙江大学金华医院小儿外科, 浙江 金华 321000
Transumbilical single-site laparoscopic surgery for congenital duodenal obstruction in neonates
LYU Chengjie1(),HU Donglai2,HUANG Shoujiang1,QIN Qi1,ZHAO Xiaoxia1,HU Shuqi1,ZHANG Yanan2,FANG Xuan2,GUO Xiaodong2,TOU Jinfa1,*()
1. Department of Neonatal Surgery, the Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
2. Department of Pediatric Surgery, Jinhua Hospital of Zhejiang University, Jinhua 321000, Zhejiang Province, China
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摘要：

目的: 探讨经脐单部位腹腔镜手术治疗新生儿先天性十二指肠梗阻（CDO）的疗效和安全性。方法: 回顾性分析2017年11月至2018年1月在浙江大学医学院附属儿童医院行经脐单部位腹腔镜手术治疗CDO的新生儿15例（单部位组），以及2017年8至10月采用传统三孔法腹腔镜手术治疗CDO的新生儿20例（三孔组）的临床资料。比较两组手术时间、术后初次进食时间、术后足量进食时间、术后住院天数和并发症等。结果: 两组手术均顺利完成，无中转开腹手术者，无术中大出血发生。单部位组手术时间十二指肠菱形吻合术为（90±10）min，拉德手术为（81±15）min；三孔组手术时间十二指肠菱形吻合术为（85±9）min，拉德手术为（72±11）min，两组差异均无统计学意义（均P>0.05）。单部位组术后初次进食时间为（5.0±1.0）d，术后足量进食时间为（9.0±1.2）d；三孔组术后初次进食时间为（4.8±0.8）d，术后足量进食时间为（9.3±0.8）d，差异均无统计学意义（均P>0.05）。术后住院天数单部位组为（11.2±2.5）d，三孔组为（11.5±2.8）d，差异亦无统计学意义（P>0.05）。结论: 经脐单部位腹腔镜手术治疗新生儿CDO与传统三孔法腹腔镜手术治疗同样安全有效，并且术后腹部切口更加隐匿。
关键词： 脐;  腹腔镜检查/方法;  十二指肠梗阻/外科学;  婴儿, 新生;  治疗结果    
Abstract:

Objective: To evaluate the efficacy and safety of transumbilical single-site laparoscopic surgery for congenital duodenal obstruction (CDO) in neonates. Methods: A retrospective analysis of clinical data of 15 patients with CDO undergoing transumbilical single-site laparoscopic treatment during November 2017 and January 2018 (single-site group), and 20 patients with CDO undergoing conventional three-hole laparoscopic treatment during August 2017 and October 2017 (three-hole group) was performed. All patients were from the Children's Hospital, Zhejiang University School of Medicine. The operation time, time of initial feeding, time of adequate feeding, length of hospital stay after operation and postoperative complications were compared between two groups. Results: The operations were completed in all patients. No patient converted to laparotomy, and no massive hemorrhage was observed during operation. The operation time of single-site group was (90±10) min for patients with duodenal diamond-shaped anastomosis and (81±15) min for patients with Ladd operation, while those of three-hole group were (85±9) min and (72±11) min, respectively. Postoperative initial feeding time of single-site group was (5.0±1.0) d, and that of the three-hole group was (4.8±0.8) d. The adequate feeding time was (9.0±1.2) d in the single-site group, and (9.3±0.8) d in the three-hole group. The length of hospital stay after operation was (11.2±2.5) d in the single-site group, and (11.5±2.8) d in the three-hole group. There was no significant difference in operation time, postoperative initial feeding time, adequate feeding time and length of hospital stay after operation between two groups (all P>0.05). Conclusion: Transumbilical single-site laparoscopic surgery for CDO in neonates is safe and effective, and the postoperative abdominal scar is more hidden.
Key words: Umbilicus    Laparoscopy/methods    Duodenal obstruction/surgery    Infant, newborn    Treatment outcome
收稿日期: 2018-03-23 出版日期: 2018-09-18
CLC:  R726.2  
基金资助: 浙江省公益性技术应用研究计划(2013C37025)
通讯作者: 钭金法     E-mail: lcjdr@zju.edu.cn;toujinfa@zju.edu.cn
作者简介: 吕成杰(1983-), 男, 硕士, 主治医师, 主要从事小儿普外、新生儿外科研究; E-mail:lcjdr@zju.edu.cn; https://orcid.org/0000-0002-6472-8178
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吕成杰
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钭金法

引用本文:

吕成杰,胡东来,黄寿奖,秦琪,赵晓霞,胡书奇,张雅楠,方旋,郭晓东,钭金法. 经脐单部位腹腔镜手术治疗新生儿先天性十二指肠梗阻的疗效和安全性观察[J]. 浙江大学学报（医学版）, 2018, 47(3): 261-265.

LYU Chengjie,HU Donglai,HUANG Shoujiang,QIN Qi,ZHAO Xiaoxia,HU Shuqi,ZHANG Yanan,FANG Xuan,GUO Xiaodong,TOU Jinfa. Transumbilical single-site laparoscopic surgery for congenital duodenal obstruction in neonates. J Zhejiang Univ (Med Sci), 2018, 47(3): 261-265.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2018.06.07    或    http://www.zjujournals.com/med/CN/Y2018/V47/I3/261

组别 n 年龄(${\bar x}$±s，d) 男性/女性(n) 体质量(${\bar x}$±s，kg) 手术方式(n)
菱形吻合术 拉德手术
“—”无相关数据.
单部位组 15 4.2±1.2 10/5 3.0±0.6 10 5
三孔组 20 4.3±1.5 13/7 2.8±0.7 12 8
t/χ2值 — 0.712 8.318 0.625 8.318
P值 — ＞0.05 ＞0.05 ＞0.05 ＞0.05
表 1  单部位组和三孔组一般资料比较
图 1  经脐单部位腹腔镜手术治疗新生儿十二指肠梗阻示意图
(${\bar x}$±s)
组别 n 手术时间(min) 术后初次进食时间(d) 术后足量进食时间(d) 术后住院天数(d)
菱形吻合术 拉德手术
“—”无相关数据.
单部位组 15 90±10 81±15 5.0±1.0 9.0±1.2 11.2±2.5
三孔组 20 85±9 72±11 4.8±0.8 9.3±0.8 11.5±2.8
t值 — 0.657 0.753 1.024 0.822 0.958
P值 — ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05
表 2  单部位组和三孔组手术及术后恢复情况比较
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