先天性十二指肠梗阻91例临床分析

Clinical Analysis For 91 Cases of Hereditary Dudenal Obstruction

目的总结先天性十二指肠梗阻的临床表现、手术方法和围手术期处理。方法回顾性分析91例年龄1h至4个月的十二指肠梗阻病例,其中先天性肠旋转不良57例,环状胰腺22例,十二指肠膜式闭锁9例,其他型十二指肠闭锁2例,异常索带1例。8例(8.8%)存在2种原因的梗阻。本组行Ladd's术57例,十二指肠前壁菱形吻合术27例,隔膜切除、十二指肠纵切横缝5例,十二指肠端端吻合术1例,索带松解术1例。结果88例治愈,1例合并肠坏死自动出院,1例术后并发坏死性小肠结肠炎、肠穿孔放弃治疗,1例术后发现合并食道闭锁,放弃治疗。结论先天性十二指肠梗阻的主要病因是肠旋转不良、环状胰腺、十二指肠膜式闭锁,早期诊断、合理选择手术方法、避免漏诊、加强围手术期处理是提高治愈率的关键。

Objective To summarize clinical manifestation, operatin methods and management of peroperative period of hereditary dudenal obstruction. Methods 91 cases with age 1h-4 months old, included 57 cases of hereditary intestine bad rotation, 22 cases of annular pancreas, 9 cases of dudenal membranous atresia, other type dudenal atresia in 2 cases, abnormal cord band in one case. 8 cases were obstruction induced with twe different causes of disease. In this report, 57 cases underwent Ladd＇s operation, 27 cases were diamond anastomosis at dudenal anterior wall, there were diaphragm resection, dudenal vertical resection, then across suture in 5 cases, dudenum end to end anastomosis in one case, cord band lysis in one case. Results 88 cases of them were cared, 3 cases occurred complication, they were necrotizine entercolitis, small intestine necrosis, respectively in one case, both automatic abandon treatment. Conclusion Main causes of hereditary dudenal obstruction are as follows; intestine bad rotation, annular pancreas, dudenal membranous atresia. Rising cure rate key is early diagnosis, the surgeon chooses optimal operation method, and avoiding missed diagnosis.