新生儿先天性十二指肠梗阻

Clinical analysis of congenital duodenal obstruction in neonates

目的探讨新生儿先天性十二指肠梗阻的病例特点、诊断要点及治疗方法选择。方法回顾性研究2002年1月至2011年12月于本院住院治疗的246例新生儿先天性十二指肠梗阻病例的临床资料，就出生情况（胎龄、胎次、产前检查及出生体重）、发病时间、临床表现、影像学检查、并发畸形、手术方法、术后并发症及预后等方面作系统比较分析。本组246例病例资料中，男173例，女73例，出生体重950～4850g，早产43例（胎龄28～36周）。病理类型包括肠旋转不良158例，环状胰腺49例，十二指肠隔膜45例，十二指肠闭锁或十二指肠狭窄7例，十二指肠异常索带1例，其中两种以上畸形合并存在14例；伴发畸形124例，以消化道畸形及先天性心脏病为主。结果所有病例均手术治疗，手术方式根据病理类型决定，行Ladd’S术、隔膜切除纵切横缝术、菱形吻合、十二指肠侧侧吻合或十二指肠空肠吻合术。术后死亡或放弃治疗17例，术后因切口裂开、吻合口瘘、肠粘连梗阻、十二指肠隔膜漏诊及肠旋转不良复发等再手术14例；术后平均（8．51±3．17）d进食，平均（14．87±5．60）d出院。结论新生儿先天性十二指肠梗阻病理类型复杂，早期诊断与及时治疗是改善预后的关键。术中应考虑到多种梗阻因素并存和伴发其他消化道畸形的可能，应仔细检查，尽可能一次手术处理。

Objective To evaluate clinical manifestations, diagnosis and treatment of congenital duodenal obstruction （CIX）） in neonates. Methods Retrospective analysis of 246 neonatal patients with CDO admitted between January 2002 and December 2011 was conducted. Clinical data including demographic criteria, clinical manifestations, associated anomalies, radiologic findings, operations, postoperative complications and final outcomes were recorded and analyzed. Total 246 newborns were enrolled in this study, with 173 boys and 73 girls. Birth weight （BW） ranged from 950 g to 4 850 g. Forty-three babies were born prematurely. One hundred and fifty eight cases were diagnosed with malrotation, 49 cases with annular pancreas, 45 cases with duodenal web, 7 cases with duodenal atresia or stenosis and 1 case of duodenal abnormal bands, while 14 cases had various combinations of these conditions. One hundred and twenty four patients had associated anomalies. Results Operative procedures included Ladd＇s procedure, duodenoduodenostomy, excision of the web and duodenoplasty, duodenojejunostomy or combination of the above. Seventeen patients died or withdraw treatment postoperatively. The causes of death were combinations of prematurity, sepsis, pneumonia, pulmonary hemorrhage, short bowel, or cardiac anomaly. Fourteen patients were reoperated for wound dehiscence, adhesive intestinal obstruction, anastomotic leak, cholestasis, missed diagnosis or recurrence of malrotation. Enteral feeding was started at an average of 8. 51 ± 3.17 days after operation, and the mean hospital stay was 14. 87 ± 5.60 days. Conclusions CIND is a complex entity with various causations and multiple accompanied diseases. Timely diagnosis and aggressive surgery are key points for better prognosis. Multiple causes of duodenal obstruction and/or associated alimentary tract anomalies should always be aware during operation.