新生儿先天性十二指肠梗阻的诊治方法探讨

Clinical diagnosis and treatment of neonatal congenital duodenal obstruction

目的探讨新生儿先天性十二指肠梗阻的诊治方法和病理特点。方法总结近7年收治的43例新生儿先天性十二指肠梗阻的临床资料,对术前诊断、病理类型及治疗方法进行回顾性分析。结果43例患儿术前均行X光立位腹部平片检查,20例行上消化道泛影葡胺造影检查,12例行钡灌肠检查,所有患儿均行手术治疗,手术证实先天性肠旋转不良22例,十二指肠闭锁及狭窄11例,环状胰腺4例,环状胰腺合并肠旋转不良3例,肠旋转不良合并十二指肠狭窄2例,十二指肠周围异常韧带1例。治愈41例,死亡2例。结论术前X线检查是诊断新生儿先天性十二指肠梗阻的有效方法,新生儿先天性十二指肠梗阻的主要原因是先天性肠旋转不良、十二指肠闭锁和狭窄、环状胰腺,部分患儿有多种原因。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 study the diagnosis and treatment of neonatal congenital duodenal obstruction and its pathological characteristics. Methods Clinical data of 43 cases of neonatal congenital duodenal obstruction treated in past 7 years were reviewed and their preoperative diagnosis, pathology classification and treatments were retrospectively analyzed. Results All babies underwent abdominal X-ray examination, 20 of them received contrast examination of upper digestive tract, and 12 babies underwent barium enema examination. Their operational records confirmed 22 cases of congenital malrota- tion of intestine, 11 cases of membranous atresia and stenosis of duodenum, 4 cases of annular pancreas, 3 cases of annular pancreas with congenital malrotation of intestine, 2 cases of congenital malrotation of intestine with membranous stenosis of duodenum and 1 case of congenital abnormal cords. Forty-one babies were cured and 2 died post-operation. Condusions Preoperative abdominal X-ray examination can be used to diagnose neonatal congenital duodenal obstruction effectively. The main pathogenic causes of duodenal obstruction in neonates are congenital malrotation, duodenal stenosis or atresia and aunular pancreas, etc. Early diagnosis and optimal management are helpful to better prognosis.