先天性肠闭锁40例临床分析

目的总结新生儿肠闭锁的诊断和治疗。方法对40例先天性肠闭锁的患儿进行回顾性分析，其中十二指肠闭锁8例，空肠闭锁8例，回肠闭锁24例；Ⅰ型15例，Ⅱ型6例，Ⅲa型17例．nlb型（Apple—peel）1例，Ⅳ型1例；行隔膜切除纵切横缝术5例，行肠侧侧菱形吻合术6例，行肠切除端端或端斜吻合术28例，肠管裁剪端端吻合（Tapering整形术）1例。结果术后吻合口梗阻5例．吻合口瘘3例．切口裂开2例。术后死亡3例，弃医1例。治愈36例，治愈率90％。结论早期诊断和选择合理的术式是提高肠闭锁治愈率，减少并发症的关键因素，静脉营养的应用促进肠功能的恢复。     

154例新生儿肠闭锁手术报道

目的 总结154例新生儿肠闭锁的手术治疗经验，探讨新生儿肠闭锁的治疗方法。方法根据肠闭锁部位选择不同的手术方式，对十二指肠闭锁患儿采取隔膜切除术、十二指肠-空肠吻合术、十二指肠侧侧吻合术、胃空肠吻合术；对空、回肠闭锁患儿采取端背吻合术、端侧吻合术；对结肠闭锁患儿采取一期吻合术。结果154例均行手术治疗，治愈126例，死亡28例，治愈率为91％。结论根据肠闭锁部位选择合适术式，加强术后管理，是提高新生儿肠闭锁治愈率的重要因素。     

先天性小肠闭锁134例诊治分析

目的总结先天性小肠闭锁的诊断与治疗经验,探讨各型小肠闭锁的手术方法及影响预后的因素。方法回顾性分析本院近5年来134例先天性小肠闭锁患儿的病例资料,其中十二指肠闭锁37例,空肠闭锁26例,回肠闭锁7I例;Ⅰ型45例,Ⅱ型22例,Ⅲa型53例,11Ib型（Appel—Peel）4例,Ⅳ型10例。根据小肠闭锁部位及病理类型选择不同的手术方式。结果134例均行手术治疗,其中16例进行了第2次手术,原因包括吻合口梗阻7例,吻合口漏5例,遗漏多发性闭锁1例,切口裂开3例。全组治愈124例,治愈率92．5％。死亡7例。放弃治疗3例。结论早期诊断和选择合理的手术方式是提高小肠闭锁治愈率、减少并发症的关键因素。Ⅰ型闭锁宜采用肠侧侧菱形吻合术或隔膜切除、纵切横缝术。Ⅱ型、Ⅲ型闭锁病例可采用近端扩张肠管切除、肠端端或端斜吻合术,或改良裁剪式肠吻合术。TPN、围手术期综合管理及改进手术材料能显著提高疗效。     

节段性肠肌层缺损伴回肠、胆道闭锁1例

患儿：男，３天，足月顺产，出生体重３．３ｋｇ。因生后腹胀、呕吐、未排胎便收入院。体检：皮肤巩膜黄染，全腹胀，肠鸣音活跃。直肠指检排出少量灰色粘液。腹部直立位Ｘ线片显示扩张肠袢及宽大液平影像，拟诊肠闭锁。术中见距回盲部３０ｃｍ处回肠段明显扩张，部分肠壁菲薄、透亮，末段回肠轻度扩张，结肠、盲肠及阑尾细小，呈胎儿型。切除扩张回肠段，行肠吻合。纵行切开回盲肠交界处，见回盲瓣处呈隔膜状闭锁，环行切除隔膜，横形缝合回盲部。切作者单位：２５６６０３　山东省滨州医学院附属医院小儿外科（傅廷亮、王兴华），病理科（…     

先天性肠闭锁／狭窄病变部位与预后关系的探讨

目的探讨特殊部位的肠闭锁／狭窄手术方法与预后的关系。方法回顾性分析本院自2006年6月至2011年6月收治的145例因肠闭锁／狭窄而行手术治疗的患儿临床资料,其中十二指肠闭锁／狭窄36例,空肠闭锁／狭窄46例,回肠闭锁／狭窄59例,结肠闭锁／狭窄4例。145例中,距屈氏韧带约20cm以内的肠闭锁／狭窄3l例,距回盲部20am以内的回肠闭锁／狭窄19例。结果总病死率为12．41％,术后并发症的总发生率为21．13％。距回盲部20cm以内的回肠闭锁／狭窄患儿术后并发症的发生率明显高于术后并发症的总发生率（P〈0．05）。结论末端回肠和结肠闭锁术后并发症的发生率高,先天性肠闭锁／狭窄的治疗强调围手术期的正确处理。     

端斜式和改良裁剪式肠吻合术治疗先天性肠闭锁84例

目的 总结84例新生儿肠闭锁的治疗经验,比较端斜式肠吻合术和改良裁剪式肠吻合术治疗先天性肠闭锁的疗效.方法 将84例先天性空回肠闭锁患儿按手术方式分成端斜式组和改良裁剪式组,观察两组术后开始进食时间、住院时间及并发症情况.结果 两组患儿胎龄、体重、入院时日龄等比较,差异无统计学意义,空肠闭锁术后开始进食时间明显慢于回肠闭锁(P＜0.05).端斜式组和改良裁剪式组比较,不论空肠闭锁或者回肠闭锁,两者在吻合口漏、梗阻并发症及死亡率方面,差异均无统计学意义(P＞0.05),改良裁剪式组术后开始进食时间和总住院时间明显优于端斜式组(P＜0.05).结论 改良裁剪式肠吻合术是治疗先天性肠闭锁的较好术式.     

先天性肠闭锁113例预后分析

目的总结先天性肠闭锁的部位、病理分型的发生率,分析影响肠闭锁预后因素。方法回顾性分析本院自2002年12月至2012年12月收治的113例先天性肠闭锁患儿临床资料,对其死亡率、术后肠梗阻发生率、术后排便时间及进食时间进行统计学分析。结果肠闭锁部位为十二指肠26例（23．0％）,空肠30例（26．5％）,回肠53例（47．0％）,结肠4例（3．5％）。按 Grosfeld 病理分型标准：Ⅰ型42例（37．2％）,Ⅱ型18例（15．9％）,Ⅲa 型27例（23．9％）,Ⅲb 型7例（6．2％）,Ⅳ型19例（16.8％）。死亡率与术后肠梗阻的发生有统计学意义（P ＜0．05）,术后肠梗阻的发生率与闭锁部位、闭锁类型相关（P ＜0．05）,与肠吻合方式无明显相关（P ＞0．05）,术后排便及进食时间与肠闭锁部位有关（P ＜0．05）。结论随着新生儿监护治疗技术的发展,先天性肠闭锁的死亡率逐步下降,肠闭锁的部位、病理分型、术后并发症（肠梗阻、短肠综合征）、合并严重的畸形是影响其预后的重要因素。     

新生儿肠闭锁118例

目的 探讨新生儿肠闭锁的外科诊断及其治疗，提高治愈率。方法 对1991－2000年外科治疗新生儿肠闭锁118例的临床资料、病理、治疗及疗效进行回顾性分析。结果 手术118例，治愈率83％，二交手术8例，术后放及死亡20例。结论 充分保留肠管的长度，裁剪端－背吻合有于肠功能的恢复，减少并发症。静脉营养的应用促进肠功能的恢复。     

先天性小肠闭锁51例

目的探讨影响先天性小肠闭锁诊断及疗效的因素。方法收集１９８０年－１９９９年经手术证实为小肠闭锁５１例，对其临床资料、病理类型，术及疗效进行分析。结果５１例均经手术治疗，治愈３６例，治愈率７０．６％。裁剪式吻合治愈率７６．３％。结论大多数病例可通过病史询问，少部分有排便的患者可结合Ｘ线检查正确诊断，产前Ｂ超检查对小肠闭锁的早期诊断有重要意义，裁剪端背吻合是最佳术式。     

钻石样吻合治疗新生儿十二指肠梗阻

目的探讨钻行样吻合（菱型吻合）在新生儿十二肠梗阻中的应用。方法对29例十二指肠梗阻患儿采用十二指肠钻石样吻合手术进行治疗,于十二指肠梗阻近端盲端横向切开,远端纵向切开,各长约1．5cm,对近远端切口行钻石样吻合。结果手术治疗29例,术后吻合口梗阻1例,吻合口漏2例,有3例进行了第2次手术,2次手术的原因包括：因多发性闭锁第1次手术时未发现1例,术后吻合口梗阻1例,吻合口漏1例。死亡3例。死亡原因：吻合口漏1例,肺部感染、败血症1例,低体重早产儿1例。手术治愈率为89％。结论采用十二指肠钻石样吻合（菱型吻合）治疗十二肠梗阻创伤小,符合乍理,术中不易损伤十二指肠乳头,可避免切除隔膜而引起的出血。对于十二指肠闭锁因近端无法切除肓袋,钻石样吻合能保证足够大的吻合口径,明显提高了十二肠闭锁的治愈率。     

Gastrointestinal maturation and implications for infant feeding

The level of gastrointestinal (GI) maturity of an individual infant is a major determinant of whether the infant will be able to meet nutritional needs by sole use of the GI tract or if parenteral means will be necessary. The GI tract is not only an organ for digestion and absorption of nutrients; it also performs major endocrine, neural and immunologic functions. In this review, anatomic, functional and biochemical development will be described and related to means by which enteral nutrition can be used in the prematurely born infant to optimize health and prevent disease.     

先天性结肠闭锁18例诊治分析

目的：探讨结肠闭锁的病因、分类、临床表现、外科治疗及预后。方法收集本院2004年10月至2013年10月收治的18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18例患儿中,外院造瘘1例,本院急诊手术17例,均在入院后8～20 h内手术。闭锁部位发生在横结肠8例,升结肠3例,降结肠2例,结肠肝曲2例,结肠脾曲2例,乙状结肠1例。Ⅲ型14例,Ⅰ型2例,Ⅱ型2例。14例行一期肠吻合术,3例行乙状结肠造瘘,1例术中放弃治疗。全组有2例死亡。结论当闭锁发生在近端结肠时应选择回结肠吻合;当闭锁盲端在脾区以远,可以保留回盲部及部分近端结肠行结结肠吻合;如果闭锁盲端超过乙状结肠或患儿一般情况较差时,应先行肠造瘘。     

Primary intestinal trichobezoars

Primary intestinal trichobezoars are uncommon clinical entities. Two such cases in children are reported along with a review of the literature.     

Multiple gastrointestinal atresias in two consecutive siblings

Two consecutive female siblings with multiple gastrointestinal atresias are described. The history of consanguinity in the parents and the presence of extensive typical pathological lesions suggest a genetically-induced developmental fault in the alimentary tract during the early embryonic period. Accepted: 29 September 2000     

先天性肠闭锁、肠狭窄120例临床分析

目的 总结先天性肠闭锁、肠狭窄的临床特点及手术治疗效果,探讨短肠综合征与预后的关系,提高临床治愈率.方法 回顾性分析120例先天性肠闭锁、肠狭窄患儿的临床表现、影像学检查、病理分型、手术方式及治愈情况,将随访的40例患儿按照术后保留肠管长度分为短肠组及非短肠组,以同年龄段正常儿童平均体重作为对照,将短肠组体重分别与非短...     

Morphometric and immunohistochemical study of jejunal biopsies from chilren with intestinal soy allergy

A morphometric and immunohistochemical restudy was made of jejunal biopsy specimens from 5 patients with soy allergy and the results obtained were compared to those from specimens taken before soy feeding and to those at a later time. All the patients had had previous cow's milk allergy with malabsorption. Gastrointestinal symptoms presented within two weeks of starting the soy based formula but in two patients the symptoms were mild and these patients were able to continue soy feeding. Jejunal biopsy specimens taken within 3 days from the reaction to soy showed villous atrophy associated with crypt hyperplasia and an increased cell renewal rate. Also, these specimens showed an inflammatory reaction in the lamina propria and in the epithelium, and the numbers of IgA- and IgM-containing cells were increased. Later, when the soy proteins were eliminated, the morphology of the jejunum improved and the cell numbers were reduced to normal.The intestinal damage and the local immune reaction caused by soy proteins are similar to those seen in cow's milk allergy with malabsorption. The immunological mechanisms operating in these diseases are thought to be the cause of these changes.     

小儿非手术所致肠梗阻的病因学分析及诊断

目的 探讨小儿非手术所致肠梗阻的病因及诊断。方法 回顾性分析2001年8月～2004年12月收治的非手术所致肠梗阻患儿25例，所有病例均摄腹部立位正位片，行腹部超声检查，6例行上消化道造影，7例钡灌肠造影，均接受手术治疗。结果 23例获得治愈，1例死亡，1例放弃治疗。11例新生儿病例经手术证实4例为小肠闭锁，3例肠旋转不良，3例十二指肠膜状狭窄，1例胎粪性腹膜炎。8月-14岁的患儿经手术证实4例为肠重复畸形，5例美克尔憩室，2例美克尔憩室合并肠套叠，1例原发性肠套叠，2例腹茧症。结论新生儿期非手术所致肠梗阻以十二指肠隔膜狭窄或闭锁、肠闭锁或狭窄、肠旋转不良多见。婴幼儿和儿童非手术所致肠梗阻主要为美克尔憩室和肠重复畸形，原发性肠套叠早期得不到诊治也可引起肠梗阻。X线检查是诊断肠梗阻的主要手段，超声检查也具有一定的价值。     

Long-term complications following intestinal malrotation and the Ladd’s procedure: a 15 year review

Background: It is accepted that children with volvulus require urgent surgery. However the long term sequelae and late complications of its surgical therapy are less well understood. We hypothesised that the surgical corrected intestinal malrotation have significant long term impact on the patients quality of life. Methods: Forty-six children with intestinal malrotation were operated on at a tertiary referral centre over a fifteen year period. Their charts were retrospectively reviewed and the patients were contacted. Results: The study revealed two distinct groups, those without complications 25 (54%) and those without 21 (46%). In the acute post operative period four (9%) patients had on going feeding difficulties and one (2%) developed chronic abdominal pain. However 12 (26%) required readmission within the first six months after the initial operation. Eleven (24%) patients were readmitted with acute bowel obstruction. Six (13%) patients required multiple admissions due to small bowel obstruction and six (13%) patients underwent further surgery for adhesion related obstruction. There were four (9%) deaths in the study group, three due to other medical conditions and one following small bowel obstruction. There was zero mortality immediately after the primary operation. There was no significant difference in the initial presentation, age and operative findings in those requiring further surgery and those who did not. Conclusions: We demonstrated that there is a significant long-term morbidity associated with intestinal malrotation even after corrective surgery. Detailed education about the potential for small bowel obstruction must be given to the parents of these children.