先天性结肠闭锁诊治新体会与文献回顾

Congenital colonic atresia： our experience and literature review

目的 探讨结肠闭锁的临床特点、诊疗策略及预后.方法 收集本院2007年6月至2017年6月收治的19例结肠闭锁患儿临床资料,总结我们在诊疗方面的经验.结果 19例患儿中,3例在术前确诊,16例术中确诊,分别在出生后17 ～ 120 h内手术.12例患儿无合并器官结构畸形,4例为多发性肠闭锁（包含1例幽门闭锁与l例肠重复畸形）,l例先天性巨结肠,1例胎粪性腹膜炎,1例肠扭转.9例行分期手术治疗,其中1例合并幽门闭锁,造瘘术后出现持续造瘘液增多,最终因败血症放弃治疗而死亡;7例患者行一期根治性手术,其中1例术后出现肠梗阻再次手术,术后提示合并先天性巨结肠,均恢复顺利;3例患儿因多发闭锁放弃治疗.结论 结肠局限性扩张是结肠闭锁术前定位诊断的重要依据;根据术者偏好及术中情况,一期吻合或造瘘均可作为选择方案,谨慎起见可考虑同时行远端结肠活检排除先天性巨结肠.

Objective To explore the clinical characteristics,thrapeutic strategies,and prognosis of colonic atresia （CA）.Methods The clinical data of 19 children with colonic atresia treated at our hospital from June,2007 to June,2017 were collected;and the diagnostic and treatment experiences were summarized.Results Among the 19 children,3 cases were confirmed before the operation,and 16 during.All the children were surgically treated 17-120 h after birth.12 children complicated with no structural organ malformation;4 had multiple intestinal atresia,including 1 case of pyloric atresia and 1 case of intestinal duplication;1 congenital megacolon;1 meconium peritonitis;and 1 intestinal twist.9 children took staging operation;among which,1 complicated with pyloric atresia,and got increasing fistulae after fistulization and died because of giving up treatment for hematosepsis.7 children were treated by one stage radical surgery;among which,1 case had intestinal obstruction after surgery and took second operation;and the postoperative results indicated complication with congenital megacolon;all recover well.3 children gave up treatment because of multiple atresia.Conclusions Colonic local dilatation is an important basis for the preoperative localization diagnosis of colonic atresia.According to the surgeons＇ preference and intraoperative conditions,primary anastomosis or enterostomy can be selected.As a precaution,distal colonic biopsy can be considered to exclude Hirschsprung＇s disease.