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目的探讨新生儿先天性十二指肠梗阻的病例特点、诊断要点及治疗方法选择。方法回顾性研究32例新生儿先天性十二指肠梗阻患儿的临床资料,就出生情况、发病时间、临床表现、影像学检查、手术方法、术后并发症及预后等方面进行分析。所有患儿均手术治疗,手术方式根据病理类型不同分别行隔膜切除、纵切横缝术,菱形吻合术,Ladd术。观察手术效果。结果 4例患儿术后出现切口感染,经切口换药愈合;2例行菱形吻合术患儿术后出现吻合口瘘,保守治疗后恢复顺利;全组患儿均随访3个月~3年,2例远期出现粘连性肠梗阻,经禁食、胃肠减压、补液等保守治疗痊愈。结论新生儿先天性十二指肠梗阻病因复杂,早期诊断与及时治疗是改善预后的关键,术中应考虑到并存和伴发其他消化道畸形的可能,应仔细检查,尽可能一次手术处理。
Objective To investigate the characteristics of neonatal congenital duodenal obstruction, the main points of diagnosis and treatment options. Methods The clinical data of 32 neonates with congenital duodenal obstruction were retrospectively analyzed in terms of birth, onset time, clinical manifestations, imaging examination, surgical methods, postoperative complications and prognosis. All children were surgically treated, according to the pathological type of surgical resection of the diaphragm, longitudinal incision, rhombic anastomosis, Ladd surgery. Observe the effect of surgery. Results Four cases of incision infection occurred after the operation and were healed by incision dressing. In two cases, anastomotic fistula was found in children with rhinoplasty and recovered well after conservative treatment. All patients were followed up for 3 months to 3 years , 2 cases of adhesive intestinal obstruction in the long run, after fasting, gastrointestinal decompression, fluid and other conservative treatment cured. Conclusions The etiology of congenital duodenal obstruction in neonates is complex. Early diagnosis and prompt treatment are the key to improve prognosis. Surgery should be considered concurrently with other gastrointestinal malformations and should be carefully examined and treated as soon as possible.