44例十二指肠梗阻患儿的产前诊断、围产期管理与治疗

目的探讨十二指肠梗阻的产前诊断、围产期管理与规范化治疗。方法本院与北京妇产医院合作建立了“先天性畸形产前诊断与围产期管理、生后治疗与随诊网络”，2001年7月至2010年9月，按此网络模式进行管理与治疗且产前诊断为十二指肠梗阻患儿共44例。总结这44例患儿的产前诊断与生后治疗及预后情况。结果44例孕妇在北京妇产医院产前常规超声检查诊断为胎儿十二指肠梗阻，来本院进行了咨询。咨询后3例选择引产，3例处于妊娠中，14例失访，24例经手术证实确诊并进行相应治疗。手术组24例产前超声征象中“双泡征”21例，羊水过多20例。出生后影像学检查：腹立位X线平片24例，其中22例显示“双泡征”，1例“单泡征”、1例“三泡征”；上消化道造影19例，均显示胃及十二指肠扩张、蠕动增强，十二指肠部位排空受阻；超声检查23例，10例显示十二指肠扩张、蠕动增强。手术方式：环状胰腺19例，均行十二指肠一十二指肠菱形吻合术；十二指肠膜式狭窄4例，行隔膜切除、肠管纵切横缝术；十二指肠离断式闭锁1例，行端一背肠吻合术；术中发现合并肠旋转不良11例，同时行Ladd手术治疗。手术患儿均治愈出院。结论对产前诊断为十二指肠梗阻的患儿应实施规范化围产期管理，出生后尽早手术治疗可取得较好的疗效。

Objective To investigate the prenatal diagnosis, perinatal management and standardized treatment protocol for neonates with duodenal obstruction. Methods A "network in prenatal diagnosis, perinatal management and monitoring of congenital malformation" was founded between Beijing Obstetrics and Gynecology Hospital and the Capital Institute of Pediatrics. Forty-four fetuses were prenatally diagnosed as duodenal obstructions by this network from July,2001 to September, 2010. The data of prenatal diagnosis, treatment after birth and prognosis were analyzed. Results Among 44 patients diagnosed as fetal duodenal obstruction by prenatal ultrasonography, three cases underwent induced abortion, three were in pregnancy, 14 were lost during follow-up and 24 were confirmed by surgical treatments after birth. Within 24 neonates underwent surgery, 21 showed "double-bubble" sign and 20 combined with polyhydroamnios in prenatal ultrasonography. Twenty-four neonates underwent upright abdominal plain film examination,22 showed "double-bubble" sign, 1 showed "single-bubble" sign and 1 showed "triple-bubble" sign,respectively. Nineteen neonates underwent upper gastroenterography which showed distention of stomach and duodenum, increased stomach peristalsis and an obstacle of duodenum emptying. Within 23 neonates underwent ultrasonographic studies, 10 showed distention and increased peristalsis of duodenum. Following surgical procedures were performed: diamond shape anastomosis was completed in 19 cases with annular pancreas; duodenal vertical resection, across suture and excision of the membrane was done in four cases with duodenum membranate stenosis; end-to-back anastomosis was taken in one case with duodenal separate atresia; Ladd's procedure was applied in 11 cases associated with malrotation. All patients were cured. Conclusions Standardized perinatal management and earlier intervention should be offered to newborns with duodenal obstruction to achieve better effects.