摘要
为探讨新生儿十二指肠梗阻的诊断与治疗方法,回顾性分析了57例年龄1天至3个月的十二指肠梗阻病例临床表现和手术治疗疗效。57例中早产儿和未成熟儿占14.0％;病种包括先天性肠旋转不良40例次,十二指肠闭锁狭窄16例次,环状胰腺6例次,肠系膜上动脉综合征1例次,其中6例(11.5％)有2种原因的梗阻。手术方式按病理改变而定,包括肠旋转不良Ladd手术40例次,隔膜切除、十指肠成形12例次,十二指肠十二指肠菱形吻合2例次,十二指肠空肠侧侧吻合9例次。有6例术中将鼻胃管插入至空肠作为“经吻合口的十二指肠支架管”,并加作腹壁筋层减张缝合。术后主要并发症有腹壁切口裂开6例,十二指肠梗阻4例(吻合狭窄3例,漏诊隔膜1例),肺炎3例。“经吻合口的十二指肠支架管”加腹壁筋膜层减张缝合术6例术后无并发症。全组死亡4例,病死率7.0％(4/57例)。提示新生儿十二指肠梗阻的主要病因是先天性肠旋转不良、十二指肠闭锁狭窄和环状胰腺,部分病例有2种原因。主要手术并发症是腹壁切口裂开和吻合口狭窄。“经吻合口的十二指肠支架管”可避免隔膜被遗漏和吻合口狭窄,腹壁筋膜层减张缝合可避免切口裂开。
In order to have a further understanding about the situation of clinical presentations,diagnosis and surgical treatment of duodenal obstruction in neonates,57 affected newborn infants aged from 1 day after birth to 3 months and also surgically treated here from January, 1991 to December, 2000 were retrospectively reviewed and analyzed. Of them, 8 cases were prematures, being 14% of the total. Through the sum-up, the fingings discovered in laparatomy included malrotation in 40 cases, duodenal membrane stenosis or atresia in 16 cases, anular pancreas in 6 cases and arteria mesenterica superior syndrome in 1 case. In addition, 6 neonates were found to have the co-existence of 2 kinds of patholgical changes. Concerning the surgical treatment, the choice of operative methods was dependent upon the pathological change. As a whole, then, Ladd's procedure, Web's excision with duodenoplasty,duodeno-duodenostom in diamond shape and duodeno-jejunos-tomy were performed in 40,12,2 and 9 patients, respectively. Simultaneously, an operative technique of trans-anastomotic duodenal tube and tension suture of fascial space of abdominal wall was applied in 6 cases when necessary. In this analysis, the principal post-operative complications were found to be the abdominal wall dehiscence in 6 cases, obstruction still remained in 4 cases(constriction of the anastomosis in 3 cases missing duodenal membrane in 1 case) and pneumonias in 3 cases, but no complications could appear in 6 neonates who had received the trans-anastomotic duodenal tube and tension suture of fascial space of abdominal wall. Finally, it was demonstrated that the mortality of this group reached at 7% (4 cases) .Therefore, the clinical conclusion could be definitely obtained as follows: the main pathogenic causes of duodenal obstruction in neonates should consist of malrotation , duodenal stenosis or atresia and aunular pancreas, etc. Besides, the dehiscence of abdominal wall and the constriction of anastomosis might be the most principal post-operative complications in these affected neonates. Valuably, the tension suture of fascial space of abdominal wall could be used to prevent from the dehiscence of abdominal wall and the use of the trans-anastotic duodenal tube could avoid the appearance of the constriction of the anastomosis.
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2002年第12期713-715,共3页
Journal of Clinical Pediatrics
关键词
新生儿
十二指肠梗阻
诊断
治疗
neonate duodenal obstruction diagnosis treatment
