十二指肠有孔隔膜状狭窄手术方法探讨

目的：评价十二指肠隔膜切除术和菱行吻合术在各年龄段十二指肠有孔隔膜状狭窄患儿中的治疗效果。方法：将72例患儿分为3个年龄组,即新生儿组（〈30 d）、小婴儿组（30~60 d）和较大婴儿组（≥60 d）;将各年龄组按手术方法分别分为隔膜切除组和菱形吻合组,比较各年龄组中隔膜切除组和菱形吻合组的手术时间、术后肠功能恢复时间（术后胆汁样粪便排出时间）、术后达到完全肠内营养时间（经口喂养达80 mL/（kg·d）-1所需时间）、术后平均住院时间、术后2月及6月的体质量（仅新生儿组和小婴儿组）、术后梗阻性黄疸的发生率、术后再发生胆汁性呕吐的发生率。结果：新生儿组中,隔膜切除组手术时间、术后达到完全肠内营养所需时间及术后住院时间低于菱形吻合组（P均〈0.05）;小婴儿组中,隔膜切除组手术时间及术后2月体质量低于菱形吻合组,但肠功能恢复时间、术后达到完全肠内营养所需时间及术后住院时间高于菱形吻合组（P均〈0.05）;较大婴儿组中,隔膜切除组肠功能恢复时间、达到完全肠内营养所需时间、术后住院时间及术后胆汁性呕吐的发生率高于菱形吻合组（P均〈0.05）。结论：对于十二指肠有孔隔膜状狭窄的患儿,在新生儿期宜采用隔膜切除术,在≥60 d时宜采用十二指肠菱形吻合术。

Operation approach to children with congenital duodenal diaphragm

Objective： To determine whether diaphragmectomy or diamond-shaped anastomosis is the more effective treatment in infants with perforate duodenal diaphragm.Methods： Seventy-two infants with congenital duodenal diaphragm were divided into neonatal group（ 30 d）,younger infant group（30 60 d） and elder infant group（≥60 d）.Each age group were divided into diaphragmectomy group and diamond-shaped anastomosis group according to the operation approach.Duration of operation,functional recovery time of alimentary canal,total enteral nutrition,postoperative hospital stay,body weight in 2 months and 6 months after surgery,postoperative incidence of obstructive jaundice,postoperative recurrence incidence of bilious vomiting were recorded and compared.Results： In neonatal group,patients who underwent diaphragmectomy showed shorter operational time,total enteral nutrition time and hospital stay,compared with diamond-shaped anastomosis patients.In younger infant group,patients who underwent diaphragmectomy had shorter operation time and lower weight in 2 months after surgery,but longer total enteral nutrition time and hospital stay,compared with diamond-shaped anastomosis patients.In elder infant group,compared with diamond-shap anastomosis group,patients in diaphragmectomy group showed longer functional recovery time,total enteral nutrition time and hospital stay,higher postoperative recurrence incidence of bilious vomiting（P 0.05）.Conclusion： To younger infants with perforate duodenal diaphragm,the diaphragmectomy was more suitable,while diamond-shaped anastomosis was better to elder ones.