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目的探讨新生儿先天性十二指肠梗阻的诊断、病理类型及治疗方法。方法对64例新生儿十二指肠梗阻患儿的术前诊断、病理类型、治疗方法及预后进行回顾性分析。其中18例行产前B超筛查。64例均经手术探查,59例术前行上消化道造影。肠旋转不良34例(合并肠坏死6例),33例行Ladd手术,4例加做肠切除、肠吻合术;十二指肠闭锁与狭窄12例,7例行隔膜切除及肠壁纵切横缝术,2例行十二指肠端端吻合术;其余3例及环状胰腺5例行十二指肠前壁菱形侧侧吻合术;2种原因梗阻者13例,其中十二指肠闭锁并肠旋转不良6例,十二指肠闭锁并环状胰腺1例,十二指肠闭锁并多发隔膜3例,环状胰腺并肠旋转不良2例,肠旋转不良并幽门隔膜1例,根据患者情况行单一或联合术式。结果行产前B超筛查患儿中12例(12/18,66.7%)怀疑十二指肠梗阻。上消化道造影的临床符合率为98.3%。64例患儿中58例痊愈(治愈率为90.6%),4例医院内死亡,2例放弃治疗。术后并发症主要包括黏连性肠梗阻5例,肠扭转、吻合口狭窄、漏诊多发畸形各1例,其中需要二次手术4例。结论产前B超有助于胎儿高位肠梗阻的早期发现;上消化道造影和B超是诊断十二指肠梗阻的有效方法;早期诊断、合理选择手术方式、避免漏诊及加强围手术期处理是提高治愈率的关键;发生肠扭转并长段肠坏死者预后不佳。
Objective To investigate the diagnosis, pathological type and treatment of congenital duodenal obstruction in neonates. Methods Preoperative diagnosis, pathological type, treatment and prognosis of 64 neonates with duodenal obstruction were analyzed retrospectively. 18 cases of prenatal B-screening. 64 cases were surgically explored, 59 cases of preoperative upper gastrointestinal angiography. 34 cases of bowel dysplasia (6 cases of intestinal necrosis), 33 cases of Ladd operation, 4 cases of bowel resection, bowel anastomosis; duodenal atresia and stenosis in 12 cases, 7 cases of diaphragm resection and the longitudinal wall of the intestine Transverse suture, 2 cases of duodenal end-to-end anastomosis; the remaining 3 cases and 5 cases of annular pancreas anterior duodenal rhombus side anastomosis; two kinds of obstruction in 13 cases, of which 12 Intestinal atresia and bowel dysplasia in 6 cases, duodenal atresia and annular pancreas in 1 case, duodenal atresia and multiple septum in 3 cases, annular pancreas and intestinal malrotation in 2 cases, bad bowel rotation and pyloric membrane in 1 case , According to the patient under a single or combined surgery. Results 12 cases (12 / 18,66.7%) suspected of duodenal obstruction in prenatal B-screening screening. Clinical coincidence rate of upper gastrointestinal imaging was 98.3%. Of the 64 children, 58 were cured (the cure rate was 90.6%), 4 were hospital fatal, and 2 gave up treatment. Postoperative complications mainly included adhesive intestinal obstruction in 5 cases, intestinal torsion, anastomotic stenosis, missed multiple malformations in 1 case, of which 4 cases required secondary surgery. Conclusions Prenatal B-ultrasound is helpful for the early detection of fetal high intestinal obstruction. Upper gastrointestinal imaging and B-ultrasonography are effective methods for diagnosis of duodenal obstruction. Early diagnosis, reasonable surgical methods, missed diagnosis and perioperative management Is the key to improve the cure rate; the occurrence of intestinal torsion and long-term intestinal necrosis poor prognosis.