先天性十二指肠梗阻的治疗

TREATMENT OF CONGENITAL DUODENAL OBSTRUCTION

①目的 分析十二指肠梗阻原因及诊断治疗要点。②方法 76例十二指肠梗阻病儿 (新生儿 4 9例 ) ,年龄 1d～ 13岁。内源性梗阻 2 6例 ,外源性梗阻 2 1例 ,复合原因性梗阻 2 9例。全部病儿均行手术治疗 ,其中3例因第一次手术梗阻解除不完全行二次手术 ;2例因合并其他消化道畸形分别在 2年和 3年后行二次手术。术后给予保暖、吸氧及有效抗生素治疗 3～ 5d。部分病儿术后给予全胃肠外营养 7～ 10d。③结果 6 5例存活 ,11例死亡 ,病死率 14 .5 %。死亡病儿均为低体质量新生儿。新生儿病死率 1985年前为 4 2 .0 % ,1985年后为 10 .0 % ,差异有显著性 (χ2 =6 .88,P <0 .0 1)。④结论 先天性十二指肠梗阻原因复杂 ,确诊后应早期手术。术中应考虑到多种梗阻因素存在和并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 study the causes, diagnosis and treatment of congenital duodenal obstruction (CDO). Methods Seventy-six CDO children (ages: from one day to 13 years old) were studied, including 26 internal, 21 external, and 29 combined obstructions. All patients underwent operation, in which three patients were re-operated because of incomplete relieve of the obstruction, and another two underwent the second operation two and three years, respectively, after the first operation due to combined malformation of digestive tract. The patients were kept warm, and given oxygen and antibiotics for three to five days after the operation. Total parental nutrition(TPN) was applied for 7-10 days after operation in recent years. Results Sixty-five cases survived and 11 cases (14.5%) died. All the death occurred in newborns with low body weight. The mortality of operated newborns was 42.0% and 10.0% before and after 1985, respectively, with a significant difference (χ 2=6.88, P<0.01). Conclusion CDO is caused by various factors, and an operation should be done once the diagnosis is made. During operation, the possibility of combined malformation of digestive tract should be inspected carefully and managed, if any, in one operation. Complications should be prevented post-operatively.