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。

Congenital membrane atresia of duodenum(a report of 32 cases)

Objective To explore the diagnosis and treatment of the congenital membrane atresia of duodenum(CMAD). Methods The clinical data of 32 cases of CMAD admitted from 1980 to 1996 were analysed retrospectively.Results Of the 32 cases,28 cases had single membrane in the duodenum,4 two membranes;and 6 accompanied with intestinal malrotation, 2 circular pancrease and 1 anal atresia. 24 patients were treated with membrane resection only,2 underwent membrane resection and gastrojejunostomy,6 underwent membrane resection plus Ladd's operation.28 cases were cured,4 cases died.Among the 28 cases discharged,20 cases were followed-up for the period from five months to three years,their sympotoms disappeared, nutrition and development were good.Conclusions Patients with CMAD have vomit, and containing bile in most cases;abdominal erect plain film shows "double bubble sign",and gastrointestinal series can help make the diagnosis.Membrane resection is the best way of therapy,but we should pay attention to correct the double membranes and other deformity,and should strengthen perioperative period management.