先天性小肠闭锁134例诊治分析  

Experience of diagnosis and treatment of small intestinal atresia

作　　者：伏雯[1] 夏慧敏[1] 余家康[1] 钟微[1] 

机构地区：[1]广州市儿童医院小儿外科,510120

出　　处：《临床小儿外科杂志》2008年第6期18-20,共3页Journal of Clinical Pediatric Surgery

摘　　要：目的总结先天性小肠闭锁的诊断与治疗经验,探讨各型小肠闭锁的手术方法及影响预后的因素。方法回顾性分析本院近5年来134例先天性小肠闭锁患儿的病例资料,其中十二指肠闭锁37例,空肠闭锁26例,回肠闭锁71例;Ⅰ型45例,Ⅱ型22例,Ⅲa型53例,Ⅲb型(Appel-Peel)4例,Ⅳ型10例。根据小肠闭锁部位及病理类型选择不同的手术方式。结果134例均行手术治疗,其中16例进行了第2次手术,原因包括吻合口梗阻7例,吻合口漏5例,遗漏多发性闭锁1例,切口裂开3例。全组治愈124例,治愈率92.5%。死亡7例。放弃治疗3例。结论早期诊断和选择合理的手术方式是提高小肠闭锁治愈率、减少并发症的关键因素。Ⅰ型闭锁宜采用肠侧侧菱形吻合术或隔膜切除、纵切横缝术。Ⅱ型、Ⅲ型闭锁病例可采用近端扩张肠管切除、肠端端或端斜吻合术,或改良裁剪式肠吻合术。TPN、围手术期综合管理及改进手术材料能显著提高疗效。Objective To summarize the diagnosis and treatment of congenital atresia of small intestine, explore the operation methods and the factors effecting prognosis. Methods The clinical data for 134 cases of small intestinal atresia over the past five years in our hospital were retrospectively analyzed, including 37 cases of duodenal atresia,26 of jejunal atresia, and 71 of ileal atresia. The types of atresia were type Ⅰ （45）, type Ⅱ（22）, type IIIa （53）, type Ⅲb （Appel-Peel）（4） and type Ⅳ （10）. Different operation methods were chosen based on atresia area and pathological type. Results 134 cases were all treated by operation, of which 16 cases were taken second surgical operation with the causes including anastomotic obstruction（7）, anastomotic leakage（5）, omission of multiple atresia（1）,and disruption of wound（3）. 7 patients died after operation, while 3 cases gave up operation. 124 patients were cured with the cure rate of 92.5%. Conclusions Early diagnosis and proper selection of operation methods are the key factors in improving cure rate of intestinal atresia and reducing complications. To diaphragmatic type I , it is suggested to adopt latero-intestine latus diamond shaped anastomosis or barrier diaphragm ectomy, longitudinally cut transverse suture method. Type Ⅱ and Type III patients should adopt proximal end broaden intestinal cut,intestinal end-to-end / end-to-back anastomosis, or reforming tapering anastomosis. Widespread use of TPN,integrated management of perioperative, and improvement of surgical materials play a significant role in enhancing curative effect.

关 键 词：肠闭锁 临床诊断 治疗方法 患者 

分 类 号：R726.5[医药卫生—儿科]