新生儿环状胰腺的临床诊治分析

Clinical analysis of annular pancreas in neonates

目的:总结新生儿环状胰腺的病例特点、诊断要点及治疗方法。方法:回顾性分析浙江大学医学院附属儿童医院2009年1月至2018年12月收治的114例新生儿环状胰腺病例的临床资料,收集患儿的出生情况(胎龄、出生体质量)、临床症状、发病时间、产前检查结果、并发畸形、影像学检查、手术方法、术后并发症等信息,并进行系统分析。结果:114例患儿中,102例行腹部超声检查,提示十二指肠梗阻68例、环状胰腺4例;113例行腹部立位X线摄片检查,提示双泡征76例、单泡征12例、高位肠梗阻5例;103例行上消化道造影检查,提示十二指肠梗阻102例。所有患儿均行手术治疗,其中十二指肠侧侧吻合术110例、十二指肠空肠吻合术4例;开腹手术45例,腹腔镜手术69例(术中中转开腹1例)。术后平均禁食时间为(7.8±2.7)d,平均住院时间为(16.9±10.1)d,出现并发症5例。产前检查异常组术后并发症的发生率较产前检查无异常组低(P<0.05);腹腔镜手术组术后平均禁食时间较开腹手术组缩短(P<0.05)。结论:出生后早期反复呕吐者需考虑环状胰腺可能。环状胰腺合并畸形率高,产前筛查异常患儿建议常规行胎儿染色体检查。手术为唯一确诊及治疗方法,腹腔镜手术可作为有经验医生的首选手术方式。

Objective: To analyze clinical manifestations, diagnosis and treatment of annular pancreas in neonates. Methods: Clinical data of 114 neonates with annular pancreas admitted in the Children’s Hospital of Zhejiang University from January 2009 to December 2018 were reviewed. The demographic parameters(gestational age, birth weight), clinical manifestations, onset time, results of antenatal examination, associated anomalies, radiological findings, operations, postoperative complications were analyzed. Results: One hundred and two cases were examined by abdominal echography, in which 68 cases showed duodenal obstruction, 4 cases showed annular pancreas. Plain abdomen X-ray examination performed in 113 cases before operation, 76 cases presented double-bubble sign, 12 cases presented single-bubble sign and 5 cases had high-position intestinal obstruction. Upper gastrointestinal radiography(UGI) was performed in 103 cases, which suggested duodenal obstruction in 102 cases. Operations were performed in all cases, of which 69 cases were operated under laparoscopy including 1 case converted to open laparotomy. The mean fasting time after surgery was(7.8±2.7) d, and the mean length of hospital stay was(16.9±10.1) d. Five patients had postoperative complications. The incidence of postoperative complications in antenatal abnormal group was lower than that in the antenatal non-abnormal group(P<0.05);the average fasting time in laparoendscopic surgery group was shorter than that in traditional laparotomy group(P<0.05). Conclusions: Neonates with recurrent vomiting early after birth should be highly suspected to have annular pancreas. The fetal chromosome examination should be performed with abnormal antenatal screening. Surgery is the only effective way to diagnose and treat annular pancreas, and laparoscopic surgery could be the first choice for experienced doctors.