摘要
目的探讨腹腔镜手术治疗新生儿食管裂孔疝的可行性。方法6例新生儿食管裂孔疝行腹腔镜食管裂孔修补胃底折叠术，术前均经X线上消化道泛影葡胺造影确立诊断，其中产前B超诊断膈疝3例，1例合并肠旋转不良同时在腹腔镜下行Ladd’s手术。结果6例患儿均在腹腔镜下顺利完成手术，男4例，女2例，年龄22h～31d，体重2．0～3．2kg。手术时间150~210min，平均178min，手术出血量1～5ml，平均2ml，均无术中、术后并发症。6例患儿随访3个月～3年，术前症状完全消失，无远期并发症发生。其中1例产前诊断为膈疝的患儿于生后22h行腹腔镜手术，至今已18个月，从未出现呕吐，营养发育佳。结论腹腔镜技术治疗新生儿食管裂孔疝具有暴露清楚、损伤小、恢复快、切口美观等优点，相对于传统手术操作，镜下器械操作更加小巧和灵活，对脏器的干扰也大为减轻，较开腹手术具有明显优势，还可以联合治疗其他疾病。需要特别注意，术者必须具备新生儿手术经验以及熟练的腔镜操作技术。
Objective To investigate the safety and outcomes of laparoscopic repair of hiatal hernia in neonates. Methods Esophageal hiatus repair and Nissen fundoplication was performed in 6 neonates with hiatal hernia between February 2006 and January 2011. Three cases were diagnosed as ＂diaphragmatic hernia＂ in prenatal ultrasonography at 27-week, 35-week, and 38-week pregnancy; They were diagnosed as hiatal hernia by gastrointestinal contrast after birth. The gastrointestinal con- trast of one case showed parasophageal hernia, volvulus of stomach and gastroesophageal reflux. Lapa- roscopic procedure was performed 22 hours after birth. One patient underwent laparoscopic Ladd＂ oper ation for combined intestinal malrotation which was shown in preoperative contrast study. Results Six patients underwent esophageal hiatus repair and Nissen fundoplieation laparoscopieally. The youngest patient was 22 hours old. The lowest weight was 2. 0 kg. The mean operation time was 178 min （150 min^210 min）. And the mean blood loss was 2 ml （1~5 ml）. Feeding was started after 36~54 h. Postoperative hospital stay was 7~ 12 days, with an average of 8. 5 days. The six patients were fol- lowed up for 3 month to 3 years. They were in good condition with no significant complications. Con- elusions This study confirmed that the laparoscopic procedure for neonate hiatal hernia is associated with minimal post-operative pain,, good outcomes, and can be applied to manage additional pathology. The surgeon should be experienced in laparoscopic operations.
出处
《中华小儿外科杂志》
CSCD
北大核心
2011年第7期484-487,共4页
Chinese Journal of Pediatric Surgery
基金
基金项目：国家十一五科技支撑计划（编号：2006BA105A06）
2010年北京市科技计划项目（编号：D101100050010064）
关键词
腹腔镜外科手术
食管裂孔疝
Laparoscopy surgical procedures
Hiatal hernia
