新生儿十二指肠梗阻123例诊疗研究

Diagnosing and treating experience of newborn duodenum intestinal obstruction 123 cases

目的探讨新生儿先天性十二指肠梗阻的诊断和治疗方法及病理类型。方法对123例新生儿十二指肠梗阻患儿的术前诊断、病理类型及治疗方法进行回顾性分析。结果 123例十二指肠梗阻患儿中,肠旋转不良56例（45%）;十二指肠闭锁与狭窄27例（21%）,其中隔膜型及风袋型13例,十二指肠狭窄7例,十二指肠闭锁9例;环型胰腺造成的梗阻11例（8%）。伴发畸形：本组患儿中合并胎粪性腹膜炎11例,肠扭转坏死4例,腹裂4例,脐膨出3例,美克尔憩室4例,先天性心脏病18例。123例患儿中117例存活（存活率95.12%）,3例医院内死亡,5例手术后1~8d内放弃治疗,11例环型胰腺及7例肠狭窄患儿全部存活。术后并发症主要包括粘连性肠梗阻（13例）、肺炎（67例）、吻合口瘘（5例）、应激性小肠溃疡（1例）、切口裂开（11例）、新生儿硬肿症（22例）。结论孕妇产前B超检查若发现胎儿胃及十二扩张或羊水过多都应该考虑胎儿高位肠梗阻的可能;生后胆汁性呕吐为常见的具有特征性的症状;术前X线平片可见双气泡或三气泡特征,上消化道造影可见造影剂阻滞和（或）通过困难,是诊断十二指肠梗阻的有效方法;早期诊断,合理选择手术方式,避免漏诊,加强围手术期处理及静脉高营养是提高治愈率的关键。

Objective To investigate the diagnosis,treatment and pathology of congenital duodenal obstruction.Methods Totally 123 cases of neonatal duodenal obstruction in children in the preoperative diagnosis,pathology,and treatment were analyzed retrospectively.Results In 123 patients with duodenal obstruction in children,56 cases of intestinal malrotation（45%）;Duodenal atresia and stenosis of 27cases（21%）,in which the bag-type membrane-type and 13 cases of duodenal stenosis in 7 cases,9 cases of duodenal atresia;Ring obstruction caused by the pancreas in 11 cases（8%）.With malformations： the merger of the group suffered 11 cases of meconium peritonitis,volvulus necrosis in 4 cases,4 cases of gastroschisis,omphalocele in 3 cases,Meckel＇s diverticulum in 4 cases,18 cases of congenital heart disease.123 cases of children in 117 patients survived（survival rate95.12%）,3 patients died in hospital,after surgery in 5 cases gave up treatment within 1~8d,11 cases of annular pancreas and 7 cases of intestinal stenosis in children all survived.Complications include adhesive intestinal obstruction（13 cases）,pneumonia（67 cases）,anastomotic leakage（5 cases）,small stress ulcer（1 case）,wound dehiscence（11 cases）,neonatal hard swelling disease（22cases）.Conclusions B ultrasound prenatal fetal stomach and 12 found to expand or fetal polyhydramnios should consider the possibility of high intestinal obstruction;After birth bilious vomiting is a common characteristic of the symptoms;Preoperative X-ray visible double-bubble or three bubble characteristics,upper gastrointestinal contrast agent visible block and（or） through difficulties,is an effective method of diagnosis of duodenal obstruction;Early diagnosis,rational selection of operative method,to avoid misdiagnosis,strengthen perioperative and intravenous high-nutrition is the key to improve the cure rate.