新生儿先天性幽门闭锁的诊断与治疗  

Congenital pyloric atresia in neonates

作　　者：耿其明[1] 唐维兵[1] 张杰[1] 陈焕[1] 路长贵[1] 吕小逢[1] 蒋维维[1] 李薇[1] 徐小群[1] Geng Qiming Tang Weibing Zhang Jie Chen Huan Lu Changgui Lyu Xiaofeng Jiang Weiwei Li Wei Xu Xiaoqun.(Department of Neonatal Surgery, Children＇s Hospital of Nanfing Medical University, Nanjing 210008, China)

机构地区：[1]南京医科大学附属儿童医院新生儿外科,210008

出　　处：《中华普通外科杂志》2017年第4期348-350,共3页Chinese Journal of General Surgery

摘　　要：目的探讨新生儿先天性幽门闭锁的诊断、手术方式及预后。方法回顾性分析南京医科大学附属儿童医院收治的新生儿幽门闭锁6例，包括幽门瓣膜完全闭锁4例，有孔瓣膜闭锁和实质性闭锁各1例。其中合并大疱表皮松解症、多发性肠闭锁和环状胰腺各1例。结果6例患儿主要症状为非胆汁性呕吐。腹部X线平片5例可见单一扩张的胃泡，5例远端无肠气。B超和上消化道造影检查显示5例胃出口梗阻，1例十二指肠球后部梗阻。对瓣膜闭锁者行瓣膜切除＋幽门成形术。实质性闭锁者行扩大的幽门成形术。1例合并肠闭锁者自动出院，随访5例患儿术后生长发育良好．无胃肠道症状。结论腹部X线平片、B超和上消化道造影检查有助于新生儿先天性幽门闭锁的诊断，合理的术式可提高患儿的生存率和减少术后并发症。Objective To investigate the diagnosis, surgical therapy of congenital pyloric atresia in neonates. Method Six congenital pyloric atresia neonates in Children＇s Hospital of Nanjing Medical University were admitted, including 4 cases of complete atresia with pyloric diaphragm, 1 case of incomplete atrsia with a foraminula in the pyloric diaphragm and 1 case of pyloric atresia with solid segment. Three cases were associated with epidermolysis bullosa, multiple intestinal atresia and annular pancreas respectively. Results The main presenting symptoms were nonbilious vomiting, and 5 cases of abdominal X-ray plain film showed a large single gastric air-bubble and no gas distally. Uitrasonography and upper gastrointestinal radiography showed complete gastric outlet obstruction, and in 1 case postbulbar obstruction. Neonates with pyloric diaphragm underwent diaphragm excision and pyloroplasty, and that with solid segment did an extended pyloroplasty. The one complicating intestinal atresia was abandened surgery. Five cases were followed up, and doing well with complete recovery. Conclusion Abdominal X-ray plain film, Doppler ultrasonography and upper gastrointestinal radiography help establish the diagnosis of neonatal congenital pyloric atresia. Surgery is the therapy of choice and the prognosis is very good.

关 键 词：幽门 婴儿 新生 

分 类 号：R726.5[医药卫生—儿科]