| 摘要: |
| 目的 总结腹腔镜Ladd手术治疗肠旋转不良患儿时中转开腹及再手术的原因，探讨其处理对策。方法 回顾性分析我院2014年1月至2017年1月107例接受腹腔镜Ladd手术治疗的肠旋转不良患儿的临床资料及手术录像，分析术中情况、术后并发症和再次手术情况等。结果 107例患儿中男88例、女19例，男女比例为4.6：1，中位年龄为28 d（1 d~14岁）；新生儿（≤ 28 d）55例，非新生儿（>28 d）52例。99例患儿腹腔镜Ladd手术成功完成。8例中转开腹手术者均为新生儿，其中因扭转方向难以判断中转者4例，合并环状胰腺1例，合并十二指肠隔膜1例，视野模糊1例，系膜血管损伤1例。15例患儿术后再手术，其中1例8岁患儿因肠梗阻于术后2周行腹腔镜探查术，术中证实为十二指肠球部溃疡穿孔；余14例均为新生儿，术中证实9例为十二指肠空肠曲松解不彻底，2例为肠粘连导致肠梗阻，1例为十二指肠隔膜导致肠梗阻，1例为结肠狭窄导致肠梗阻，1例为关闭切口时缝合肠管导致术后肠穿孔。结论 腹腔镜Ladd手术治疗肠旋转不良安全可行，但在新生儿中开展手术仍有一定困难。完善术前检查、严格把控手术适应证、采取不同的手术策略、掌握娴熟的腹腔镜操作技术有助于提高腹腔镜Ladd手术成功率。 |
| 关键词: Ladd手术 腹腔镜 肠旋转不良 新生儿 中转开腹手术 再手术 |
| DOI：10.16781/j.0258-879x.2020.11.1294 |
| 投稿时间：2020-02-24修订日期：2020-06-11 |
| 基金项目: |
|
| Conversion to open surgery and reoperation in laparoscopic Ladd's procedure for intestinal malrotation in children: an analysis of the causes |
| LEI Hai-yan,YAN Xue-qiang*,BIAN Hong-qiang,DUAN Xu-fei,YANG Jun,ZHU Zhen-chuang |
(Department of General Surgery, Wuhan Children's Hospital(Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430016, Hubei, China
*Corresponding author) |
| Abstract: |
| Objective To summarize the causes for conversion and reoperation of laparoscopic Ladd's procedure in children with intestinal malrotation, so as to explore the countermeasures. Methods The clinical data and surgical videos of 107 children with intestinal malrotation, who underwent laparoscopic Ladd's procedure from Jan. 2014 to Jan. 2017 in our hospital, were retrospectively analyzed. The intraoperative findings, postoperative complications and reoperation were analyzed. Results There were 88 males and 19 females, with the ratio of male to female being 4.6:1, and the median age was 28 d (1 d to 14 years), with 55 neonates (≤ 28 d) and 52 non-neonates (>28 d). Laparoscopic Ladd's procedure was successfully performed in 99 cases. All the eight cases converted to open surgery were neonates. Among them, four cases were difficult to judge the rotation direction, one case complicated with annular pancreas, one case with duodenal septum, one case with blurred visual field, and one case with mesenteric vascular injury. A total of 15 cases underwent reoperation. One 8-year old patient underwent laparoscopic exploration 2 weeks after laparoscopic Ladd's procedure due to intestinal obstruction, and duodenal ulcer perforation was confirmed during the operation; the remaining 14 cases were all neonates. During the reoperation of the 14 neonates, nine cases were confirmed as incomplete lysis of the initial end of duodenum jejunum, two cases were caused by intestinal adhesion, one case by duodenal diaphragm, one case by colonic stenosis, and one case by intestinal perforation due to intestinal obstruction closure of the incision. Conclusion Laparoscopic Ladd's procedure is safe and feasible in the treatment of intestinal malrotation, but there are still some difficulties in neonatal patients. It is helpful to improve the success rate of laparoscopic Ladd's procedure by improving the preoperative examination, strictly controlling the operation indications, adopting different surgical strategies and skilled laparoscopic techniques. |
| Key words: Ladd's procedure laparoscopy intestinal malrotation neonate conversion to open surgery reoperation |
