64例肠重复畸形的外科治疗

Operative treatment for 64 cases of intestinal duplication deformity

目的探讨肠重复畸形的外科治疗方法。方法1960年4月-2007年1月,兰州大学第一医院手术治疗肠重复畸形64例,男43例,女21例,平均年龄8.4岁(75d-31岁)。25例因发生急性并发症(包括肠梗阻4例,便血11例,腹膜炎5例,腹痛并腹部包块5例)而行手术治疗,另外39例因其他疾病行腹部手术时发现而切除。结果2例因并发其他疾病死亡(3.13%%),其余均治愈(96.87%),随访期间均发育正常,排便良好。结论肠重复畸形相对少见,手术是唯一有望治愈的方法,但术前诊断率仅15.2%-45.7%。X线、B超、CT、MRI等有助于诊断,部分患者出现急性并发症时才就诊。术中应采取个体化处理,行重复畸形切除或连同主肠管一并切除,壁内囊肿型者行肠切除肠吻合,而结肠重复畸形宜行结肠大部切除,残余结肠行共壁切开吻合术。本病预后均较好。

Objective To explore treating method of intestinal duplication deformity. Methods 25 cases of intestinal duplication deformity： man 43 cases, female 21 cases, average age was 8.4 years old （75d-31 years） were operated in our hospital, 25 cases because occurred acute complication （including 4 cases of intestinal obstruction, 11 cases of hematochezia, 5 cases of peritonitis, abdomen pain complicated with abdominal enveloped mass） were operated. Other 39 cases duplication intestines which were detected at other abdomen operation of other disease were removal. Results 2 cases died from complicated with other disease （3.13%）, all the other patients were cured （96.87%） development normal, defecation good. Conclusions Morbidity of the intestinal duplication deformity is low relatively,. Operative therapy is only effective way, but its diagnostic rate only 15.2%- 45.7% before the operation. X-ray, B-uhrasonography, CT, MRI etc examinations can help the diagnosis of the deformity. Partly patients go to see a doctor until occurred acute complication. Individual treating scheme should be applied, to take duplication deformity removal, or it with main intestinal tract can be resected altogether, wall intrinsic cyst type duplication deformity could removal the intestine, and enteroanastomosis, however colon duplication deformity should removal the greater part colon, the remanent colon should take a common wall incision, then enteroanastomosis should be done. The disease has a good prognosis.