腹腔镜下Ladd手术治疗先天性肠旋转不良21例
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摘要
目的:回顾性研究腹腔镜下行Ladd手术治疗先天性肠旋转不良的安全性及疗效。方法:在腹腔镜下行Ladd手术治疗先天性肠旋转不良21例,其中男性14例,女性7例,年龄58 min～4岁。结果:21例患儿,均行腹腔镜下Ladd手术,3例中转开腹,9例有肠扭转,1例合并急性化脓性阑尾炎,1例合并美克尔憩室,1例合并乳糜腹。手术时间52～125 min,平均65 min。术后均随访1～2年,腹部瘢痕不明显,全组病例恢复顺利,无并发症。结论:腹腔镜下应用Ladd手术治疗先天性肠旋转不良安全可靠,值得临床推广。
Objective: To retrospectively study the safety and efficacy of laparoscopic Ladd's procedure for congenital intestinal malrotation. Methods: Laparoscopic Ladd's procedure was performed in 21 children with congenital intestinal malrotation,including14 males and 7 females,aged 58 min to 4 years. Results: Laparoscopic Ladd's procedure was performed in 21 children. 3 cases were converted to laparotomy,9 cases had intestinal volvulus,1 case was complicated with acute suppurative appendicitis,1 case was complicated with Meckel's diverticulum,and 1 case was complicated with chylabdomen. The operation time was 52-125 min,with an average of 65 min. All children were followed up for 1-2 years,and the abdominal scar was not obvious. All children recovered smoothly without complications. Conclusion: Laparoscopic Ladd's procedure is safe and reliable in the treatment of congenital intestinal malrotation. It is worth popularizing in clinic.
Objective: To retrospectively study the safety and efficacy of laparoscopic Ladd's procedure for congenital intestinal malrotation. Methods: Laparoscopic Ladd's procedure was performed in 21 children with congenital intestinal malrotation,including14 males and 7 females,aged 58 min to 4 years. Results: Laparoscopic Ladd's procedure was performed in 21 children. 3 cases were converted to laparotomy,9 cases had intestinal volvulus,1 case was complicated with acute suppurative appendicitis,1 case was complicated with Meckel's diverticulum,and 1 case was complicated with chylabdomen. The operation time was 52-125 min,with an average of 65 min. All children were followed up for 1-2 years,and the abdominal scar was not obvious. All children recovered smoothly without complications. Conclusion: Laparoscopic Ladd's procedure is safe and reliable in the treatment of congenital intestinal malrotation. It is worth popularizing in clinic.
引文
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[11]陈快,黄金狮,戴康临,等.腹腔镜与开腹Ladd手术治疗新生儿肠旋转不良效果比较[J].临床小儿外科杂志,2011,10(2):128-129,148.
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[13]KIESEWETTER W B,SMITH J W. Malrotation of the midgut in infancy and childhood[J]. AMA Arch Surg,1958,77(4):483-491.
[14]STAUFFER U G,HERRMANN P. Comparison of late results in patients with corrected intestinal malrotation with and without fixation of the mesentery[J]. J Pediatr Surg,1980,15(1):9-12.
[15]STEWART D R, COLODNY A L, DAGGETT W C.Malrotation of the bowel in infants and children:a 15-year review surgery[J]. Surgery,1976,79(6):716-720.
[16]汪静.先天性肠旋转不良症的诊治[J].中华胃肠外科杂志,2002,5(1):12.
[2]HAQUE S,KOREN J P. Laparoscopic Roux-en-Y gastric bypass in patients with congenital malrotation[J]. Obes Surg,2006,16(9):1252-1255.
[3]REN P T,LU B C. Intestinal malrotation associated with colon cancer in an adult:report of a case[J]. Surg Today,2009,39(7):624-627.
[4]朱维继,吴汝舟.实用外科手术学[M].北京:人民卫生出版社,1997:573-574.
[5]PRASIL P,FLAGEOLE H,SHAW K S,et al. Should malrotation in children be treated differently according to age?[J]. J Pediatr Surg,2000,35(5):756-758.
[6]黄雄,李会,徐伟珏,等.新生儿先天性肠旋转不良的诊治探讨[J].中国新生儿科杂志,2010,25(4):240-241.
[7]潜丽俊,纪建松,韦铁民,等.小儿先天性肠旋转不良的CT诊断[J].中华胃肠外科杂志,2010,13(2):158-159.
[8]侯燕莉,荆长有.新生儿先天性肠旋转不良影像表现浅析[J].中国医疗前沿,2011,6(4):72-73.
[9]CHEN W X,JI J S,ZHANG H,et al. Value of spiral CT in diagnosing infantile intestinal malrotation[J]. Zhonghua Yi Xue Za Zhi,2010,90(15):1054-1056.
[10]SPIGLAND N,BRANDT M L,YAZBECK S. Malrotation presenting beyond the neonatal-period[J]. J Pediatr Surg,1990,25(11):1139-1142.
[11]陈快,黄金狮,戴康临,等.腹腔镜与开腹Ladd手术治疗新生儿肠旋转不良效果比较[J].临床小儿外科杂志,2011,10(2):128-129,148.
[12]ANDRASSY R J,MAHOUR G H. Malrotation of the midgut in infants and children[J]. Arch Sur,1981,116:158.
[13]KIESEWETTER W B,SMITH J W. Malrotation of the midgut in infancy and childhood[J]. AMA Arch Surg,1958,77(4):483-491.
[14]STAUFFER U G,HERRMANN P. Comparison of late results in patients with corrected intestinal malrotation with and without fixation of the mesentery[J]. J Pediatr Surg,1980,15(1):9-12.
[15]STEWART D R, COLODNY A L, DAGGETT W C.Malrotation of the bowel in infants and children:a 15-year review surgery[J]. Surgery,1976,79(6):716-720.
[16]汪静.先天性肠旋转不良症的诊治[J].中华胃肠外科杂志,2002,5(1):12.