新生儿先天性十二指肠梗阻的发病基础及临床意义

Pathogenesis and clinical significance of congenital duodenal obstruction in neonates

目的:总结新生儿先天性十二指肠梗阻的发病基础及临床特点,探讨合适的治疗方法、预后及意义。方法:针对十二指肠梗阻的不同类型选用不同的手术方式,十二指肠隔膜者采用隔膜切除、横行缝合的方式;环状胰腺和十二指肠闭锁者,采用上端横切、下端纵切的菱形吻合法;肠旋转不良者采用Ladd手术方式。结果:32例患儿中治愈30例,死亡2例,合并脑瘫1例,治愈率为93.75%。结论:严重的十二指肠梗阻在胎儿期可通过B超发现"双泡征"提前确诊,生后出现频繁的呕吐应想到本病的可能,30%泛影葡胺上消化道造影是简单易行的确诊方式,手术是治疗的关键,治疗及时者预后良好。

Objective： To summarize the pathogenesis and clinical characteristics of congenital duodenal obstruction in neonates, explore appropriate therapy, prognosis, and significance. Methods： Different surgical methods were used to treat different types of duodenal obstruction, the neonates with duodenal diaphragm were treated with diaphragm resection and transverse suture; the neonates with annular pancreas and duodenal atresia were treated with diamond anastomosis （upper transection and lower longitudinal cut） ; the neonates with intestinal malrotation were treated with Ladd surgery. Results ： Among 32 neonates, 30 neonates were cured and 2 neonates were dead, one neonate was found with cerebral palsy, the curative rate was 93.75%. Conclusion： Severe duodenal obstruction can be diagnosed definitely during fetal period by type B ultrasound characterized by ＂double - bubble sign＂ , more attention should be paid to the neonates with frequent vomiting after birth, upper gastrointestinal tract examination with 30% gastrografin is a simple and easy method to diagnose duodenal obstruction definitely, surgery is the key of treatment, the neonates treated timely have good prognosis.