A review of laparoscopic Nissen fundoplication in children weighing less than 5 kg
A review of laparoscopic Nissen fundoplication in children weighing less than 5 kg
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DOI：
10.1016/j.jpedsurg.2010.02.078
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发表时间：
2010-06-01
影响因子：
2.4
通讯作者：
Kane, Timothy D.
中科院分区：
文献类型：
--
作者：
Shah, Sohail R.;Jegapragasan, Mithulan;Kane, Timothy D.
目的：越来越多的小婴儿和新生儿接受微创手术。在这项研究中，我们描述了我们机构对体重小于 5 公斤的儿童进行腹腔镜尼森胃底折叠术 (LNF) 的经验。方法：自 2003 年 1 月以来，一家三级儿科医院尝试对体重小于 5 公斤的儿童进行 LNF 的所有病例均经过机构审查委员会批准。结果：在研究期间，122 名体重小于 5 公斤的儿童接受了 LNF。它们的年龄从 2 周到 3 岁不等（平均 94 +/- 61.3 天），体重 1.94 到 4.99 公斤（平均 3.68 +/- 0.77 公斤）。百分之二十九 (n = 35) 患有神经系统损伤。百分之八十八 (n = 107) 同时放置了胃造口管。八人（7%）转为剖腹手术。平均手术时间为 112 +/- 46 分钟。 71% (n = 87) 需要在重症监护病房平均呆 14.3 +/- 17.4 天。开始肠内喂养的平均时间为 2.6 +/- 2.6 天。 31% (n = 38) 需要术后机械通气平均 12.0 +/- 20.6 天。平均住院时间为 36.6 天至 36.0 天（范围：3-175 天）。六名患者 (5%) 出现并发症或复发性胃食管反流。三名患者出现复发性反流，其中一名患者接受了另一次 LNF。一名患者出现胃穿孔。另一种情况是在复发性食管裂孔疝修补术中发现包裹破损后需要重做 LNF。最后，一名患者在放置肝脏牵开器时出现副肝动脉出血。结论：腹腔镜尼森胃底折叠术可以安全有效地在小儿（< 5 kg）中进行，其结果和并发症发生率与之前发表的针对较大儿童的报告相似。然而，这些儿童确实长期接受重症监护并使用机械通气，这与他们的早产和严重的合并症有关。由爱思唯尔公司出版
Purpose: Minimally invasive procedures in small infants and neonates are being performed in increasing numbers. In this study, we describe our institution's experience with laparoscopic Nissen fundoplications (LNFs) in children weighing less than 5 kg.Methods: All cases of LNF attempted in children weighing less than 5 kg since January 2003 at a tertiary-care pediatric hospital were reviewed after Institutional Review Board approval.Results: One hundred twenty-two children weighing less than 5 kg underwent LNF during the study period. They ranged from 2 weeks to 3 years of age (mean, 94 +/- 61.3 days) and weighed 1.94 to 4.99 kg (mean, 3.68 +/- 0.77 kg). Twenty-nine percent (n = 35) were neurologically impaired. Eighty-eight percent (n = 107) had concurrent gastrostomy tube placement. Eight (7%) were converted to laparotomy. The average operative time was 112 +/- 46 minutes. Seventy-one percent (n = 87) required intensive care unit use for an average of 14.3 +/- 17.4 days. The average time to start enteral feeds was 2.6 +/- 2.6 days. Thirty-one percent (n = 38) required postoperative mechanical ventilation for an average of 12.0 +/- 20.6 days. The average hospital length of stay was 36.6 perpendicular to 36.0 days (range, 3-175 days). Six patients (5%) had a complication or recurrent gastroesophageal reflux. Three patients had recurrent reflux, one of which underwent another LNF. One patient had a gastric perforation. Another required a redo LNF after a disrupted wrap was noted at a recurrent hiatal hernia repair. Lastly, one patient had bleeding from an accessory hepatic artery with liver retractor placement.Conclusions: Laparoscopic Nissen fundoplication can safely and effectively be performed in small children (< 5 kg) with similar outcomes and rates of complication as previously published reports in larger children. These children, however, do have prolonged intensive care unit and mechanical ventilation use associated with their prematurity and significant comorbidities. Published by Elsevier Inc.