小肠重复畸形血运的观察及新术式应用

Duplications of Small Intestine:A Study of Vascular Supply and New Operative Procedure

目的:观察小肠重复肠管的血运与相应主肠管的血运之间的关系,探讨单纯切除重复肠管的可行性。方法:对78例患儿的81个小肠重复畸形肠管进行观察,男53例,女25例,平均年龄2.9岁。结果:根据重复肠管的血运可将肠重复畸形分为两型:并列型(Ⅰ型)和系膜内型(Ⅱ型)。81例重复肠管中,Ⅰ型61例(75.3%),以囊肿形居多;Ⅱ型20例(24.7%),以管状为多。Ⅱ型91.6%合并胸椎椎体畸形,而Ⅰ型仅6.2%合并胸椎畸形。2年来对14例患儿行单纯切除重复肠管而保留主肠管的手术,其中Ⅰ型11例,Ⅱ型3例,术中分别离断重复肠管的直动脉和直动脉的短支,切除重复肠管,主肠管的血运未受影响。术后随访无肠狭窄及梗阻发生。结论:小肠重复畸形可分为并列型和系膜内型,后者可能因胚胎早期脊柱原肠分离障碍所致。重复肠管有相对独立的血运,单纯切除之,主肠管的血运不受影响。

Objective:To investigate the vascular supply of intestinal duplication and introduce a new operative procedure to preserve a normal intestine.Methods:From 1972 to 1996,78 pa- tients with intestinal duplication were treated surgically,and 14 underwent resection of the dupli- cation without the adjacent intestine.Results:The duplications,by our way of division according to the blood supply,were parallel type(type Ⅰ,75.3%)and intramesenteric type(type Ⅱ, 24.7%).Both types containing seperate blood supply to the adjacent normal intestine enabling a resection of the duplication without the normal intestine.Fourteen cases(type Ⅰ 11,type Ⅱ 3) were treated by this method and followed-up for 4 years with satisfactory results.Conclusions: Most intestinal duplications have separable vascular supply.Complete resection of the duplication with preservation of normal adjacent intestine is a satisfactory operative procedure