| Purpose：Summarize the clinical therapeutic effect of the Laparoscopic surgerytreatment of pediatric digestive tract malformationMaterials and methods： This retrospective analysis was carried out on518children admitted to soochow university affiliated children’s hospital from August2010through July2013， who undergone surgical treatment of pediatric digestive tractmalformation. These children suffered from hiatus hernia、congenital hypertrophic pyloricstenosis、congenital malrotation of intestine、Meckel’s diverticulum、alimentary tractduplication, congenital intestinal atresia/stenosis congenital biliary dilatation andHirschsprung disease and they ranged in age from1d to12years old.174cases wereassigned to laparoscopic surgery and the others were assigned to traditional surgery.Comparing differences in surgical operation time, postoperative recovery， postoperativehospital stay and postoperative complications between them. Consistent with themeasurement data, normal distribution used t-test; not in line with normal measurementdata used the wilcoxon rank. Statistical significance was accepted when the value of p wasless than0.05sum test.Result：In518children,179underwent complete or partial laparoscopic treatment.Nine of the ten children with hiatus hernia were independently in the laparoscopic surgery.None was converted to open procedure and there was no complication during the operation.The average length of operational time was122.5minutes. Eating was followed bypostoperative2to3days. About5~7days were required for a hospital stay after surgery.One child happened with lower esophageal strictures after surgery so he was treated withcompensation and recovered well. The clinic symptoms was disappeared or release in allchildren. In135children with congenital hypertrophic pyloric stenosis,56children werefinished by the laparoscopy and no one child was converted to open procedure. The mean operative time in laparoscopy and open procedure was40.56±13.27and47.47±13.32minutes. The result has a remarkable difference with traditional surgery.Eating was followed by6h~24hours after the operation. Comparing with traditionalsurgical, postoperative diet recovery time or hospital stay was statistically significant.There was one child happened with Pyloric mucosal perforation and then underwent in theemergency downlink perforation repair and gastrostomy and recovered well. In46childrenwith congenital malrotation of intestine;13of them were finished by the laparoscopy; onewith annular pancreas and one with small intestine torsion720degrees, which led toestablishing Pneumoperitoneum difficultly, were converted to open procedure. The lengthof operational time was118.46±31.98minutes, which was longer than conventionalsurgery time (76.29±25.75minutes)(P>0.05). Laparoscopy has no obvious advantages,however it showed shorter hospital stay. All the children with therapeutic laparoscopywere discharged7.5±1.83days after operation. There was one child with adhesiveobstruction happened in these13patients, however he recovered well after surgery. Andone child with navel abscess also recovered well after puncture drainage. Among smallintestinal malformations (38cases with congenital malrotation of intestine;21cases withmeckel’s diverticulum),28of them were finished by the partial laparoscopy;4of themwith diverticulum perforation adhesion and2of them with bigger bump were converted toopen procedure. However, operation time, postoperative recovery diet and postoperativehospital stay all had differed significantly from traditional operation, which was superior tothe latter. Among congenital biliary dilatation disease, there were30patients finished bythe partial laparoscopy, however2children with cyst excision were converted to openprocedure. It really took a long time (~130to630minutes) to do this operational procedure,that is because early experience is insufficient. The length of operational time was196.73±73.18minutes (excepting early3cases for a longer time) comparing withconventional surgery(198.50±57.44minutes). However, there was no statisticalsignificance in operation time between both operative methods (P>0.05). Two childrenwith gastroenteritis admitted to hospital were treated with compensation and recoveredwell. Furthermore, there were no other postoperative complications for laparoscopicsurgery. Among145children with Hirschsprung disease,30of them were finished by thelaparoscopy and no one child was converted to open procedure, and there was no bloodtransfusionin operation. There were three with enterocolitis and one with corrupt dung and four with incomplete ileus after operation in them.80of them were finished by the transanlpull-through, and there were ten with enterocolitis and five with corrupt dung afteroperation in them.35of them were finished by the transabdominal pull-through, and therewere eight with enterocolitis and three with corrupt dung and five with incomplete ileusafter operation in them. The operation time（187.14±41.41scores） of the laparoscopyapproach was longer than the transanl pull-through （114.31±39.55scores） andtransabdomina（l167±24.39scores）.Eating recovery time after operation in the three groupswas2.28±0.96days，4.31±1.42days and6.20±2.77days respectively. The postoperativehospitalization time for the three groups was7.42±1.33days，9.31±2.13days and15.00±9.87days respectively, which was less than the traditional operation.Conclusion：1、 The effect of laparoscopic treatment in hypertrophic pyloric stenosis andesophageal hiatal hernia is not significantly different from the traditional surgery. But thesurgery time, the regular diet resumed time and the hospitalized days are all shorter thanthe traditional surgery. Moreover, the postoperative complications are less than thetraditional surgery. So laparoscopic treatment could completely replaced the traditionalsurgery.2、Children with intestinal malformation （Meckel’s diverticulum、alimentary tractduplication）were treated by laparoscopic assisted treatment, avoiding the traditional openoperation incision. And there were many advantages such as finding the lesion site anddeformity more quickly intraoperative..3、Laparoscopic treatment in choledochal cysts was usually relatively complex. Thatis because the high endoscopic technique was required during the operation. However,laparoscopic intraoperative cholangiography and pancreatography help to further clarifythe anatomic abnormalities, and moreover, the laparoscopic endoscopic magnified visioncontributes to observing the local anatomy. Despite the longer operation time, advantagessuch as better recovery. So it will replacing the open gradually.4、Laparoscopic treatment in the long segment Hirschsprung disease had obviousadvantages. It could make judging pathological bowel range easier and tell us whether thecolon was in torsion and shorten the operation time of anus. As the short segment type andcommon type,.the laparoscopic technology was no obvious advantage. 5、The effect of laparoscopic treatment in the neonatal gastrointestinal malformation,such as intestinal malrotation and intestinal atresia, was similar with traditional operationfor the Pathological types of uncomplicated.. But for the children with complex pathologyor multiple malformations, we carry out less laparoscopic treatment and that is because ofgreat difficulty and higher conversion rate, which needs us to increase clinical experienceand further discussion. |
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