Diagnosis and treatment of congenital malrotation of the intestine: a summary of 10 years of experience in a single center

doi:10.3877/cma.j.issn.1674-3946.2024.03.027

Abstract

Abstract:

Objective

The cases of congenital malrotation of the intestine in a single center for 10 years were retrospectively analyzed and the experience was summarized.

Methods

The clinical data of 155 children with congenital malrotation treated by operation from January 2012 to February 2022 were retrospectively analyzed. According to different surgical methods, they were divided into laparoscopic group (n=60) and open group (n=95). The laparoscopic group was divided into 6 stages according to the sequence of operation time (group A to group F, with an average of 10 cases in each group). SPSS 23.0 was used for statistical analysis. Measurement data such as perioperative indicators were expressed as () and independent sample t test was used. Postoperative complications were represented by [cases (%)] and χ² test was used. P<0.05 was considered statistically significant.

Results

The operation time of laparoscopic group was longer than that of laparotomy group, the intraoperative bleeding was more than that of laparotomy group, and the total hospital stay was shorter than that of laparotomy group (P < 0.05). There was no significant difference in postoperative recurrence of intestinal torsion, adhesive intestinal obstruction and incision infection between the two groups (P > 0.05). The learning curve of laparoscopic operation time was plotted, and it was found that after 20 cases of operation, the operation time changed from the learning period to the proficiency period.

Conclusion

Laparoscopic surgery for malrotation can reduce the length of hospital stay, but the operation time is longer, the learning curve of laparoscopic malrotation reduction is about 20 cases, and it is safe and feasible to perform this procedure by an experienced team.

Key words: Congenital Intestinal Malrotation, Child, Laparoscopes, Postoperative Complications

Weijun Zheng, Yifan Fang, Dianming Wu, Xiang Wang, Fei Chen, Mingkun Liu. Diagnosis and treatment of congenital malrotation of the intestine: a summary of 10 years of experience in a single center[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(03): 338-341.

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URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2024.03.027

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References 15

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组别	例数	性别（例）	出生体重(kg,)	分娩方式（例）	早产（例）	临床症状[例（%）]
组别	例数	男/女	出生体重(kg,)	顺产/剖腹	是/否	呕吐/腹胀
腹腔镜组	60	42/18	3.2±3.7	35/25	5/55	57(95.0)/2(3.3)
开腹组	95	69/26	3.2±5.3	53/42	7/88	86(90.5)/6(6.3)
χ2/t值		0.125	0.663	0.097	0.048	1.030	0.198
P值		0.723	0.508	0.755	0.827	0.310	0.656

组别	例数	性别（例）	出生体重(kg,)	分娩方式（例）	早产（例）	临床症状[例（%）]
组别	例数	男/女	出生体重(kg,)	顺产/剖腹	是/否	呕吐/腹胀
腹腔镜组	60	42/18	3.2±3.7	35/25	5/55	57(95.0)/2(3.3)
开腹组	95	69/26	3.2±5.3	53/42	7/88	86(90.5)/6(6.3)
χ2/t值		0.125	0.663	0.097	0.048	1.030	0.198
P值		0.723	0.508	0.755	0.827	0.310	0.656

组别	例数	手术时间(min)	术中出血(ml)	开奶时间(d)	住院时间(d)
腹腔镜组	60	118.6±32.0	3.9±5.9	5.3±2.4	9.5±2.1
开腹组	95	82.4±21.7	2.1±1.1	4.9±1.5	11.1±5.7
t值		7.329	2.383	1.187	2.110
P值		<0.01	0.040	0.192	0.030

组别	例数	手术时间(min)	术中出血(ml)	开奶时间(d)	住院时间(d)
腹腔镜组	60	118.6±32.0	3.9±5.9	5.3±2.4	9.5±2.1
开腹组	95	82.4±21.7	2.1±1.1	4.9±1.5	11.1±5.7
t值		7.329	2.383	1.187	2.110
P值		<0.01	0.040	0.192	0.030

组别	例数	肠扭转复发	粘连性肠梗阻	切口感染	阑尾残端瘘	总并发症
腹腔镜组	60	4(6.7)	6(10.0)	1(1.7)	0(0.0)	11(18.3)
开腹组	95	2(2.1)	5(5.3)	5(5.3)	0(0.0)	12(12.6)
x²值		1.993	1.251	1.436	-	0.946
P值		0.207	0.263	0.406	-	0.331

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