171例新生儿先天性十二指肠梗阻临床分析  

A retrospective analysis of 171 neonates with congenital duodenal obstruction

作　　者：王聪[1] 张志波[1] Wang Cong;Zhang Zhibo(Department of Neonatal Surgery,Shengjing Hospital of China Medical University ,Shenyang 110004, China)

机构地区：[1]中国医科大学附属盛京医院新生儿外科,沈阳110004

出　　处：《国际儿科学杂志》2017年第12期877-881,共5页International Journal of Pediatrics

摘　　要：目的探讨导致新生儿先天性十二指肠梗阻的各种疾病的发病率、临床特点与诊治要点的区别。方法回顾性分析中国医科大学附属盛京医院新生儿外科2006年至2015年收治的先天性十二指肠梗阻的临床资料，总结其临床特点与预后等的关系。结果171例患儿纳入研究，其中男106例，女65例；早产儿26例，足月儿145例；十二指肠瓣膜和闭锁55例，环状胰腺39例，肠旋转不良89例（70例合并中肠扭转），其中15例患儿合并上述两种以上异常。胆汁性呕吐是最常见的临床表现。41．52％患儿在生后24小时内出现症状，十二指肠瓣膜或闭锁、环状胰腺症状出现的时间早于肠旋转不良症状出现的时间，差异有统计学意义（P〈0．01）。辅助检查主要包括腹部x线片、超声及上消化道造影，其诊断十二指肠梗阻的阳性率分别为73．10％，37．14％，100％，差异有统计学意义。产前检查发现异常的患儿其确诊时间及手术时间要明显早于生后出现症状才诊断的患儿（P〈0．01）。合并两种以上畸形组的患儿术后禁食时间及住院时间与其他组相比要更长。171例患儿中，162例患儿进行手术（9例因肠管广泛坏死术中放弃），153例完成手术，145例治愈，25例退院，1例死亡，治愈率为94．77％（145／153）。术后短期并发症主要包括切口感染、切口裂开、肠穿孔、吻合口瘘。结论十二指肠瓣膜或闭锁、环状胰腺与先天性肠旋转不良是导致先天性十二指肠梗阻的常见原因，男孩多见，其中先天性肠旋转不良最为常见，肠旋转不良患儿症状出现时间较晚，上消化道造影诊断的阳性率最高，产前发现异常的患儿术后恢复时间并不早于生后诊断的患儿，多发畸形患儿治疗时间较长，多数患儿预后较好。Objective To investigate the incidence, clinical characteristics, diagnosis and treatment of various congenital duodenal obstruction in neonates. Methods Cases diagnosed with congenital duodenal ob- struction admitted to Sbengjing Hospital from 2006 to 2015 were collected. Clinical characteristics and prognosis were then analyzed. Results One hundred and seventy-one patients were included（ 106 males and 65 females）, among which 26 were premature and 145 mature. In these patients,55 were diagnosed with duodenal atresia or stenosis,39 annular pancrea, 89 midgnt malrotation（70 associated with midgut volvulus）, and 15 with at least two conditions above. Bile vomiting was the most common clinical manifestation. For 41.52% of the patients, symptoms occurred within the first 24 hours after birth, and children with duodenal stenosis, duodenal atresia, or annular pancreas were significantly linked with earlier symptoms than patients with intestinal malrotation. Posi- tive diagnosis rate of abdominal plain film, abdominal doppler ultrasonography, and upper gastrointestinal con- trast were 73. 10%, 37.14%, and 100%, respectively, with significant difference （ P 〈 0. 01 ）. Compared with those whose first diagnosis were executed postnally,patients whose anomalies were found prenatally were diag- nosed and operated significantly earlier（P 〈 0. 01 ）. Postoperative fasting time and hospitalization time of patients with various malformations were significantly longer than groups with single anomaly. Among the 171 cases, 162 were performed operation（9 cases abandoned treatment because of extensive intestinal necrosis） ,145 cases re- covered well 25 quitted,and 1 died, with a cure rate of 94.77%. Postoperative short-term complications included incision infection,unwound,intestinal perforation and anastomotic fistula. Conclusion The causes of congenital duodenal obstruction include duodenal atresia or stenosis, annular pancreas and congenital intestinal malrotation, among which congenital intestinal malrotati

关 键 词：先天性十二指肠梗阻 新生儿 临床特点 

分 类 号：R722.1[医药卫生—儿科]