258例儿童先天性十二指肠梗阻诊治的回顾性分析

A retrospective analysis for the diagnosis and treatment of 258 children with congenital duodenal obstruction

目的:收集258例先天性十二指肠梗阻的病例资料,分析并总结该病在儿童不同年龄段的临床特点和诊治要点。方法:收集我院2003年至2012年间收治的258例先天性十二指肠梗阻病例,对临床病例资料进行分组回顾性分析,总结临床特点及诊治要点。结果:(1)先天性十二指肠梗阻多在新生儿期发病(χ2=10.658 3,P=0.005);(2)胆汁性呕吐(76.36%)是本病最突出的临床症状(χ2=37.482 1,P=0.000);(3)腹部平片、腹部超声多普勒及上消化道造影对本组病例的阳性发现率分别为78.57%、73.71%和100%,有显著性差异(P=0.000);(4)先天性肠旋转不良、十二指肠闭锁或狭窄、环状胰腺是先天性十二指肠梗阻最常见的病因;先天性十二指肠梗阻一经确诊,应尽早手术,预后好(本组治愈率96.88%)。结论:先天性十二指肠梗阻诊断成立应尽早手术,预后多较好。

Objective：To analyze clinical characteristics and main treatment points in different age periods among 258 children with congenital duodenal obstruction. Methods：Totally 258 children with congenital duodenal obstruction were treated in our department from 2003 to 2012 and were divided into two groups：neonatal group（ 184 cases）and non-neonatal group （74 cases）. The clinical char- acteristics and main treatment points were analyzed and reviewed retrospectively. Results： （1）Congenital duodenal obstruction mainly appeared during neonatal period（x2=10.658 3,P=0.005）. （2）Bilious vomiting（76.36%）was the most prominent clinical symptom（ X2=37.482 1 ,P=0.000）. （3）Positive detection rates of abdominal plain film, abdominal Doppler uhrasonography and upper gastrointesti nal contrast were 75.87%,73.71% and 100.00%,respectively with significant differences（P=0.000）. （4）The common causes of con- genital duodenal obstruction were congenital intestinal malrotation, duodenal atresia or stenosis and annular pancreas. When the di- agnosis of congenital duodenal obstruction was confirmed, surgical operation should be done as early as possible and the prognosis was significantly better after earlier surgical treatment in most cases （curative rate of 96.88%）. Conclusion：The diagnosis for the children with congenital duodenal obstruction diseases should be established as soon as possible and the prognosis should be better.