先天性肠道重复畸形的诊治与预后评估

Evaluation of the diagnosis and treatment and prognosis of the congenital double intestine

目的 对 23例先天性肠道重复畸形患儿的临床症状、诊断方法及治疗予以总结。方法 22例患儿均有反复且无明显腹部症状的下消化道出血，术前有 15例用 99mTc检查，全部患儿术中切除重复的肠管及部分正常肠管后、行正常肠管端端吻合术。结果 报告小肠腔内有放射性分泌物异常积存，提示肠腔内有异位胃粘膜或出血灶。结论 无明显症状不明原因的下消化道反复出血、排除下消化道炎症、肿瘤、凝血机制障碍等疾病后，应考虑先天性肠道重复畸形出血的可能。该疾病可因肠道感染或胃及胰腺粘膜异位产生酸或碱性物质，腐蚀肠粘膜及血管破裂而产生大出血。 99mTc检查效果良好，出血时检查阳性率高且为无创性。切除病变，预后良好。

Objective To evaluate the diagnosis,the treatment and the prognosis of the congenital double intestine of 23 patients. Methods Resected double intestine and partial normal intestine,all patients were performed end－ to－ end intestinal anastomosis.15patients were taken 99mTc examination before the operation.Results The exam revealed the accumulation of abnormal radioactive secretion in the small intestine,meaning that there is an ectopic mucosa of stomach or hemorrhagic focus in the intestine.Conclusion The patients presented the hemorrhage of lower digestine tract of unkown cause,we should consider the diagnosis of congenital enteric duplication malformation after exclusion of the intestinal infections,tumors and blood coagulation anomalies diseases.The intestinal infections or the ectopic gastric and pancreas mucosa can produce acid and basic substances,which can destroy the intestinal mucosa(putrefaction)and cause vascular rupture and so to a massive hemorrhage.The 99mTc test has a good effect,its positive rate is very high if it is practiced during the hemorrhage.