新生儿肠闭锁的诊治与预后

Diagnosis,Treatment and Prognosis of Neonatal Intestinal Atresia

目的探讨新生儿肠闭锁(IA)的诊断、治疗与预后,以进一步提高治愈率。方法对本院2004年4月-2008年11月行手术治疗的29例先天性IA患儿临床资料进行回顾性分析。本组29例生后均有呕吐,15例有正常胎粪排出史,19例腹上区可见胃肠型,腹部立位平片示21例可见胃宽大液平面及数个扩张小肠液平、余8例仅见胃内的宽大液平,余部位无气体。术中见回肠闭锁16例,十二指肠闭锁7例,空肠闭锁6例;闭锁类型:Ⅰ型、Ⅱ型、Ⅲa型各9例,Ⅲb型(Apple-pee1)、Ⅳ型各1例;行IA近远端修剪端斜吻合术17例,IA隔膜切除纵切横缝术9例,IA近远端切除端端吻合术3例。术后29例均予全静脉营养支持。结果29例全部存活。其中治愈28例,1例术后放弃治疗。28例均未发现吻合口瘘及切口裂开等并发症。术后发生吻合口梗阻1例,经保守治疗后痊愈。26例术后获随访3个月～4 a,生长发育良好,无腹胀、腹痛。2例失访。结论早期诊断、合理的术式选择及围术期处理是提高IA治愈率的关键。

Objective To explore diagnosis,treatment and prognosis of intestinal atresia（IA） in neonates, so as to increase the healing rate. Methods Surgical treatment was given to 29 eases of congenital IA from Apr. 2004 to Nov. 2008. Comprehensive analysis was carried out on clinical manifestations and flat X - ray. All cases were with vomiting, 15 eases were with normal fetal faeces. Stomach and intestinal atresia were observed in the upper abdomen in 19 cases,fluid levels in generous stomach and expended intestines were seen in 21 cases by X - ray. All children underwent operation,including ileum atresia（ 16 eases） ,duodenal atresia（7 cases） ,and jejunal atresia（6 cases）. The types of atresia were type ] （9 cases） ,type Ⅱ（9 cases） ,type Ⅲa（9 cases） ,type Ⅲb（ 1 case） and type Ⅳ（ 1 case）. Nine eases were treated with septum resection and then anastomosed longitudinally,3 cases underwent end - to - end anastomose and 17 underwent end - to - hack anastomose. All cases were served in intravenous hyperalimentation. Results All eases lived postoperatively, and 1 child gave up for postoperatively treatment. Twenty - eight cases were cured. There was 1 ease of obstruction of anastomatic, and was cured by non - operatively treatment. There was no anastomatic leakage and wound disruption. Twenty - six cases were followed up for 3 months and up to 4 years. These symptoms had no relapse. Conclusion Early diagnosis,appropriate surgical procedure and surrounding operation management are crucial for improving the cure rate.