26例先天性十二指肠梗阻的外科治疗

目的 探讨先天性十二指肠梗阻的病因、临床表现、手术方法及术后处理.方法 回顾性分析我院1993年10月至2010年10月期间治疗的26例先天性十二指肠梗阻患者的临床资料.结果 26例先天性十二指肠梗阻患者中肠旋转不良16例,行Ladd手术,其中1例因术中发现广泛肠坏死家属放弃治疗,其余15例痊愈.4例单纯十二指肠膈膜者行十二指肠膈膜切除术(纵切横缝),3例单纯十二指肠狭窄者行十二指肠空肠吻合术,均痊愈.单纯环状胰腺2例,行十二指肠-十二指肠菱形吻合术或十二指肠空肠吻合术后均痊愈.肠系膜上动脉压迫综合征1例,行十二指肠空肠吻合术后痊愈.结论 先天性十二指肠梗阻是常见的新生儿急症,早期诊断,正确处理不同类型梗阻,加强围手术期处理,是提高治愈率的关键.     

腹腔镜下诊治儿童肠系膜上动脉压迫综合征8例

目的：探讨儿童肠系膜上动脉压迫综合征（ superior mesenteric artery syndrome ,SMAS）的临床特征、诊断与腹腔镜治疗方法。方法2006年7月～2012年7月,对8例保守治疗无效的SMAS行腹腔镜手术,包括单纯Treitz韧带松解术7例,Treitz韧带松解联合十二指肠空肠侧侧吻合术1例（术中粘连严重,单纯Treitz韧带松解术不充分）。结果8例均腹腔镜下顺利完成手术,单纯Treitz韧带松解术7例手术时间45～80 min,Treitz韧带松解联合十二指肠空肠侧侧吻合术1例100 min。无术中并发症,术后3～5 d开始饮食。术后所有患儿随访6～24个月,平均8个月。1例单纯Treitz韧带松解术后症状无改善,术后3个月行腹腔镜十二指肠空肠侧侧吻合术。2例行肠吻合者无吻合口漏、狭窄及梗阻,饮食正常,生长发育良好,6例单纯Treitz韧带松解术后恢复好,饮食正常。结论 B超、CT和X线钡餐检查是诊断儿童SMAS的重要方法。腹腔镜下单纯Treitz韧带松解或Treitz韧带松解联合十二指肠空肠侧侧吻合术是安全、简单、有效的治疗方法。     

先天性十二指肠膜状闭锁（附32例报告）

目的 探讨先天性十二指肠膜状闭锁的诊断和治疗。方法 对1980－1996年间收治的32例十二指肠膜状闭锁的临床资料进行回顾性分析。结果 十二指肠单隔膜者28例,双隔膜者4例;伴肠旋转不良者6例,环状胰腺2例,肛门闭锁1例。单纯隔膜切除24例,隔膜切除加结肠后胃空肠吻合2例,隔膜切除加Ladd′s手术6例。痊愈28例,死亡4例。随访20例,随访时间5个月－3年,症状均消失,营养发育良好。结论 先天性十二指肠膜状闭锁患儿,生后即有顽固性呕吐,多含有胆汁,腹部立位片有“双泡征”,经胃肠道造影检查可帮助确诊。隔膜切除是最有效的治疗方法,术中需注意双隔膜存在及其他伴发畸形的矫治。同时应加强围手术期处理。     

腹腔镜下吻合术治疗新生儿十二指肠梗阻

目的探讨腹腔镜下吻合术治疗新生儿十二指肠梗阻(congenital duodenal obstruction,CDO)的疗效。方法回顾分析2008年12月～2011年9月53例CDO患者临床资料。腹腔镜组27例,Ⅱ型、Ⅲ型十二指肠闭锁及环状胰腺15例行十二指肠菱形吻合术,十二指肠狭窄及Ⅰ型十二指肠闭锁8例行十二指肠纵切横缝术,4例Ⅰ型十二指肠闭锁行十二指肠菱形吻合术;开腹组26例,以上3种术式分别为12例、8例、6例。对比2组手术时间、术后住院时间、术后进食时间、住院费用及术后并发症情况。结果与开腹组相比,腹腔镜组术后进食时间早[(5.8±1.6)d vs.(7.5±2.2)d,t=-3.060,P=0.004],但手术时间长[(113.8±39.2)min vs.(94.0±31.0)min,t=2.034,P=0.047]。2组术后住院时间和住院费用、并发症发生率差异无显著性(P>0.05)。结论腔镜下吻合术治疗新生儿十二指肠梗阻疗效肯定,在术后肠功能恢复上明显优于传统开腹手术。     

腹腔镜诊治新生儿先天性十二指肠梗阻54例

目的 总结腹腔镜诊治新生儿十二指肠梗阻的经验.方法 回顾性分析2015年10月～2019年5月54例新生儿先天性十二指肠梗阻资料.年龄1～26 d,中位数1 d;出生体重1155～4400 g,平均2771.9 g.术前诊断十二指肠梗阻,其中肠旋转不良合并肠扭转12例,环状胰腺28例,十二指肠膜式闭锁14例.结果 腹腔...     

经脐单部位腹腔镜治疗新生儿十二指肠梗阻

目的探讨经脐单部位腹腔镜治疗新生儿十二指肠梗阻的安全性和可行性。方法回顾性分析我院2016年9月～2018年3月13例经脐单部位腹腔镜手术治疗新生儿十二指肠梗阻的临床资料。年龄0～26 d(中位数1 d),体重2500～4400(2992±506) g。先天性肠旋转不良伴肠扭转3例,环状胰腺6例,十二指肠闭锁4例。环脐周置入3枚trocar完成手术,辅以2～3根丝线悬吊。结果 13例均完成经脐单部位腹腔镜手术,无中转手术。手术时间(126. 4±24. 3) min,术后开始吃奶时间(6. 1±2. 1) d,总住院时间(12. 6±2. 7) d。术后随访1～13个月(平均7. 5月),无吻合口狭窄及吻合口漏,无肠旋转不良肠扭转复发。脐部伤口愈合良好,瘢痕被脐部皱褶掩盖。结论经脐单部位腹腔镜手术治疗新生儿十二指肠梗阻安全可行,具有美观、微创的优势。     

腹腔镜手术治疗新生儿环状胰腺的护理体会

<正>环状胰腺是先天性的胰腺发育畸形,是指胰腺组织未正常分布在十二指肠框内,而是呈环形或钳形部分或完全包绕十二指肠降部,从而引起十二指肠完全性或不完全性梗阻,是先天性十二指肠梗阻的原因之一,占先天性十二指肠梗阻的10%~30%[1],一经诊断,需手术治疗。随着腹腔镜技术在小儿外科的发展及镜下缝合技术的不断成熟,腹腔镜技术对新生儿腹部疾病的诊治逐渐得到推广[2]。2012年3月至2013年3月我科为10例环状胰腺新生儿行腹腔镜手术诊     

十二指肠空肠吻合术治疗肠系膜上动脉综合征的评价

目的:评价十二指肠空肠吻合术治疗肠系膜上动脉综合征((SMAS)的价值。方法:分析1959年1月—2012年12月采用十二指肠空肠吻合术治疗的SMAS88例患者的临床资料。结果:本组患者主要症状为餐后上腹胀痛和频繁呕吐,呕吐物含胆汁;经CT检查结合X线钡餐造影诊断为SMAS。88例均经手术治疗,其中70例(79.5%)效果优良,痊愈出院;18例(20.5%)效果不良,又出现术前症状,术后2周~3个月再行钡餐X线造影显示十二指肠空肠吻合口通畅,十二指肠逆蠕动仍然强烈,逆蠕动顺蠕动,钡剂逆流入胃,胃扩张无力。此18例二次改行十二指肠环形引流术,术后痊愈。结论:SMAS一旦成为习惯性逆蠕动,就难以消除,即使行十二指肠空肠吻合术解除十二指肠梗阻,临床症状也不能改善,其治疗关键是解决逆蠕动问题。采用十二指肠环形引流术能解决十二指肠内容物的引流方向,使呕吐等症状消除。     

肠系膜上动脉压迫综合征20例报告

目的探讨肠系膜上动脉压迫综合征（superior mesenterie artery syndrome,SMAS）的术式选择。方法对我院2000年1月至2007年12月期间收治的行手术治疗的20例SMAS的临床资料进行回顾性分析。结果本组行Treitz韧带松解加十二指肠空肠侧侧吻合术9例,Treitz韧带松解加十二指肠空肠Roux-en-Y吻合术5例,均痊愈;行胃大部切除、胃空肠吻合术4例,均好转;单纯胃空肠吻合术2例,术后症状均仅有所改善,1例改行十二指肠空肠Roux-en-Y吻合术后痊愈,另1例非手术治疗1个月后治愈。结论SMAS的手术治疗效果以Treitz韧带松解加十二指肠空肠吻合术为最佳。     

腹腔镜手术在慢性胰腺炎治疗中的应用

目的 探讨腹腔镜手术治疗慢性胰腺炎的安全性及可行性。方法 收集2015年1月至2020年12月期间采用腹腔镜手术治疗的21例慢性胰腺炎患者的临床资料,其中胰管结石伴主胰管梗阻10例,胰头部肿块形成7例,胰腺实质明显萎缩4例。结果 中转开腹3例;手术时间175～430 min（中位数305 min）,术中出血量100～800 mL（中位数260 mL）。手术方式包括腹腔镜胰十二指肠切除术8例,腹腔镜胰管切开取石联合空肠吻合术（Partington术）5例,腹腔镜全胰十二指肠切除术4例,腹腔镜改良Beger术2例,腹腔镜胰体尾切除术2例（1例保留脾脏）。术后腹腔引流管拔除时间2～14 d（中位数8 d）。术后出现生化瘘3例,胃排空延迟2例。术后住院时间6～21 d（中位数9 d）。围手术期无死亡病例,无B、C级胰瘘,无非计划再次手术发生。随访12～84个月（中位数36个月）,无胰腺恶性肿瘤发生,无脾梗死。结论 腹腔镜手术治疗慢性胰腺炎安全可行。     

Annular pancreas in the adult: management with laparoscopic gastrojejunostomy

Annular pancreas is an uncommon congenital anomaly associated with duodenal atresia in neonates. Rarely, the condition may manifest later in life. These symptoms include abdominal pain, nausea, and vomiting and usually arise due to obstruction to gastric emptying. Abdominal CT scan with high resolution and angiography protocol and magnetic resonance imaging are useful in confirming the presence of annular pancreas. Operative management involves bypassing the obstructed duodenum. Duodenoduodenostomy is routinely performed in neonates with annular pancreas. In adults, the duodenum is less mobile, and duodenojejunostomy or gastrojejunostomy are recommended. We report two cases of annular pancreas in adults treated with laparoscopic gastrojejunostomy.     

Complications associated with surgical treatment of congenital intrinsic duodenal obstruction

Although survival rates for infants undergoing surgical treatment for congenital intrinsic duodenal obstruction are high, long-term follow-up suggests a high complication rate related to surgical therapy. We reviewed 33 neonates who underwent surgery for congenital intrinsic duodenal obstruction during the past 10 years. There were 20 girls and 13 boys; the mean gestational age was 36 weeks, and mean birthweight was 2,485 g. Bilious vomiting and intestinal obstruction were the most frequent presenting symptoms. Hydramnios was present in 75% of cases and 21% had associated Down's syndrome. Findings at laparotomy included duodenal atresia (14), annular pancreas (11), and duodenal diaphragm (8). The most frequent surgical procedure was side-to-side duodenoduodenostomy (DD), followed by duodenojejunostomy and resection of web with Heineke-Mikulicz type duodenoplasty. Bowel transit was reestablished at a mean of 13.1 days (range, 6 to 45 days). Seventy-percent of patients developed postoperative complications, the most frequent being megaduodenum with blind loop syndrome or bile reflux gastritis (22%), cholestatic jaundice (17%), gastroesophageal reflux (17%), delayed transit (8%), and bowel obstruction (8%). Six patients (18%) required secondary surgical procedures for postoperative complications (ie, megaduodenum, nonfunctioning anastomosis, missed intrinsic stenosis). Two patients died (6%). Stagnation and functional obstruction in the proximal duodenum is the main factor influencing the morbidity rate among these patients. Consideration should be given to the tapering duodenoplasty and diamond-shaped anastomosis in order to help reduce problems associated with megaduodenum and help restore earlier bowel transit.     

Evaluation of the portal vein after duodenoduodenostomy for congenital duodenal stenosis associated with the preduodenal superior mesenteric vein, situs inversus, polysplenia, and malrotation

A male infant weighting 2970 g with total situs inversus, polysplenia, malrotation, duodenal stenosis, and complex cardiac anomalies, was admitted to our hospital. At 4 days of age, he underwent surgery that revealed a blood vessel passing over the duodenum from the mesenterium to the porta hepatis. A loose overbridging duodenoduodenostomy was performed to prevent compression of the vessel. The cardiac anomalies were corrected, and he could eat unrestricted diets. At the age of 1 year and 3 months, a 3-dimensional computed tomographic scan demonstrated that the vessel on the duodenum was the superior mesenteric vein (SMV), and it formed the portal vein with the splenic vein at the porta hepatis. Further, the scan revealed no compression of the SMV at the anastomosis. Doppler ultrasonography revealed a normal portal blood flow of 118.6 mL/min. This report describes the junction between the SMV and the splenic vein in a patient who had the SMV passing over the duodenum from the mesenterium. Correctly, patients previously diagnosed with a preduodenal portal vein could have a preduodenal SMV. The loose overbridging duodenoduodenostomy had advantages not only in passage of the anastomosis but also in maintenance of the portal blood flow for the congenital duodenal obstruction with the preduodenal SMV.     

Congenital causes of duodenal ulcers in adults.

In seven cases of congenital anomalies in adults, duodenal obstruction and peptic ulcer disease developed. There were two cases of congenital duodenal web, two of hypertrophic pyloric stenosis, two of annular pancreas, and one of a preduodenal portal vein. The diagnosis is seldom made preoperatively. In the four patients who had preoperative gastric analysis, the acid secretions were increased. Those patients who underwent endoscopy had changes consistent with hypertrophic secretory gastrophy and duodenitis. We believe that treatment should be directed toward relief of the duodenal obstruction and the reduction of basal acid secretion by truncal vagotomy in all such cases.     

小儿环状胰腺五例报告

目的：探讨小儿环状胰腺引起消化道梗阻的原因与临床特点。方法：对本组5例手术治疗的小儿环状胰腺的临床特点、手术所见及尸检结果进行综合分析，从中寻找各年龄组间肠梗阻原因、病理改变及并发畸形的关系。结果：新生儿环状胰腺均表现为高位完全性肠梗阻症状，多合并十二指肠膜状闭锁；年长儿则出现慢性不完全性肠梗阻症状，常为环状胰腺压迫十二指肠所致。环状胰腺直接引起十二指肠狭窄占35．8％。结论：有症状的环状胰腺患儿均应手术治疗，手术方法以建立通畅的消化道为原则，术中应详细探查有无肠闭锁等并发畸形。     

Preduodenal portal vein: surgery and radiographic appearance

Preduodenal portal vein is rare, with 63 cases reported in the literature. In general, this anomaly occurs in children with associated small bowel obstruction. We report a newborn infant who presented with duodenal stenosis, mongolism, and preduodenal portal vein. Treatment consisted of a duodenoduodenal anastomosis without mobilizing the portal vein. The correlation between imaging techniques and the operative findings is discussed. Because identification of preduodenal portal vein at surgery is important, preoperative sonography may be useful in selected cases to define the position of the vein.     

A case report of laparoscopic duodenal atresia repair in a neonate using a novel miniature stapling device

IntroductionLaparoscopic duodenal atresia repair is an advanced procedure performed in select pediatric surgical centers. Recently, sub–6 mm endosurgical staplers have been introduced, facilitating and accelerating the creation of intracorporeal intestinal anastomoses.Presentation of caseWe performed a laparoscopic duodenojejunostomy in a one-day-old child with duodenal atresia due to annular pancreas using a novel 5.8 mm articulating endostapler with excellent outcome. The technical details are reported.DiscussionLaparoscopic duodenojejunostomy is a technically demanding procedure due to difficulty in hand-sewn anastomosis in a small and restricted space. With this novel 5.8 mm articulating endostapler, we were able to perform a quicker and easier anastomosis.ConclusionWe report a case of laparoscopic duodenal atresia repair in a neonate using a novel miniature stapling device. This new technique is a safe, quick and easier way to perform laparoscopic duodenal atresia repair.     

Annular pancreas in children: a recent decade's experience

Purpose

Annular pancreas is a recognized cause of duodenal obstruction in children. The authors sought to characterize the clinical, radiologic, and prognostic findings in this disorder through a 10-year review of all patients with annular pancreas.

Methods

A retrospective review of all annular pancreas cases identified between 1993 and 2002 at 2 tertiary pediatric surgical centers was completed. Factors analyzed included patient demographics, presenting symptoms, associated anomalies, radiologic findings, operation performed, postoperative outcomes, and complications.

Results

Sixteen patients were identified. Four patients (25%) were premature. Twelve patients (75%) presented during the first week of life and the remainder within the first year. All patients presented with vomiting, which was nonbilious in 15 (94%). Five patients (31 %) had chromosomal anomalies, and 6 (38%) had other major congenital malformations. Eleven patients (69%) presented with partial duodenal obstruction. Operations performed were duodenoduodenostomy in 14 (88%), duodenojejunostomy in 1 (6%), and Ladd’s procedure in 1 (6%). Enteral feedings were started, and full enteral feeding was achieved at an average of 8.4 days and 15.9 days after operation, respectively. All patients survived and were discharged after an average hospitalization of 24.0 days.

Conclusions

Patients with annular pancreas have preampullary duodenal obstruction, which is more commonly partial. Duodenoduodenostomy is the appropriate treatment. Prognosis is excellent, despite the frequent association with chromosomal anomalies and major congenital malformations.