内镜下隔膜切开术治疗儿童先天性十二指肠隔膜效果分析

Efficacy and safety of endoscopic diaphragm incision in children with congenital duodenal diaphragm

目的探讨内镜下十二指肠隔膜切开术治疗儿童先天性十二指肠隔膜的有效性及安全性。方法回顾性分析2019年10月至2022年5月在广州市妇女儿童医疗中心消化科住院确诊的8例十二指肠隔膜并接受内镜下十二指肠隔膜切开术治疗患儿的临床资料,包括患儿一般情况、临床表现、辅助检查、内镜治疗及随访情况等。结果8例患儿中男4例、女4例,发病年龄为0~12月龄,病程为6~18个月,确诊年龄为6~20月龄,主要表现为反复腹胀、非胆汁样呕吐及营养不良。1例合并顽固性低钠,首诊于本院内分泌科,考虑非典型性先天性肾上腺皮质增生症,曾予氢化可的松治疗,血钠恢复正常,呕吐仍反复。1例在外院经历腹腔镜下十二指肠菱形吻合术,术后仍反复呕吐,内镜下发现十二指肠双隔膜。8例均无合并其他畸形,十二指肠隔膜均位于十二指肠降段,十二指肠乳头均位于隔膜下方。3例先用球囊扩张隔膜,探查十二指肠隔膜开口范围后切开隔膜,5例导丝探查隔膜口后直接实施隔膜切开术,8例均经内镜下隔膜切开术成功治疗,手术时间为12~30 min。术中无肠穿孔、活动性出血、十二指肠乳头损伤。术后1个月随访,术后体重比术前体重增加0.4~1.5 kg,增长了5%~20%。术后随访时间2~20个月,8例十二指肠梗阻均获解除,未再出现呕吐和腹胀,正常进食。3例术后2~3个月复查胃镜,十二指肠球腔无变形,原十二指肠隔膜切口黏膜光滑,直径6~7 mm。结论内镜下十二指肠隔膜切开术治疗儿童先天性十二指肠隔膜安全、有效,创伤小,具有良好的临床应用价值。

Objective To explore the efficacy and safety of endoscopic diaphragm incision in pediatric congenital duodenal diaphragm.MethodsEight children with duodenal diaphragm treated by endoscopic diaphragm incision in the Department of Gastroenterology of Guangzhou Women and Children′s Medical Center from October 2019 to May 2022 were enrolled in this study.Their clinical data including general conditions,clinical manifestations,laboratory and imaging examinations,endoscopic procedures and outcomes were retrospectively analyzed.ResultsAmong the 8 children,4 were males and 4 females.The diagnosis was confirmed at the age of 6-20 months;the age of onset was 0-12 months and the course of disease was 6-18 months.The main clinical manifestations were recurrent non-biliary vomiting,abdominal distension and malnutrition.One case complicated with refractory hyponatremia was first diagnosed with atypical congenital adrenal hyperplasia in the endocrinology department.After treatment with hydrocortisone,the blood sodium returned to normal,but vomiting was recurrent.One patient underwent laparoscopic rhomboid duodenal anastomosis in another hospital but had recurred vomiting after the operation,who was diagnosed with double duodenal diaphragm under endoscope.No other malformations were found in all the 8 cases.The duodenal diaphragm was located in the descending part of the duodenum,and the duodenal papilla was located below the diaphragm in all the 8 cases.Three cases had the diaphragm dilated by balloon to explore the diaphragm opening range before diaphragm incision;the other 5 had diaphragm incision performed after probing the diaphragm opening with guide wire.All the 8 cases were successfully treated by endoscopic incision of duodenal diaphragm,with the operation time of 12-30 minutes.There were no complications such as intestinal perforation,active bleeding or duodenal papilla injury.At one month of follow-up,their weight increased by 0.4-1.5 kg,with an increase of 5%-20%.Within the postoperative follow-up period of 2-20 months,all the 8 children had duodenal obstruction relieved,without vomiting or abdominal distension,and all resumed normal feeding.Gastroscopy reviewed at 2-3 months after the operation in 3 cases found no deformation of the duodenal bulbar cavity,and the mucosa of the incision was smooth,with a duodenal diameter of 6-7 mm.ConclusionEndoscopic diaphragm incision is safe,effective and less invasive in pediatric congenital duodenal diaphragm,with favorable clinical applicability.