新生儿先天性十二指肠梗阻的发病基础及临床意义

目的:总结新生儿先天性十二指肠梗阻的发病基础及临床特点,探讨合适的治疗方法、预后及意义。方法:针对十二指肠梗阻的不同类型选用不同的手术方式,十二指肠隔膜者采用隔膜切除、横行缝合的方式;环状胰腺和十二指肠闭锁者,采用上端横切、下端纵切的菱形吻合法;肠旋转不良者采用Ladd手术方式。结果:32例患儿中治愈30例,死亡2例,合并脑瘫1例,治愈率为93.75%。结论:严重的十二指肠梗阻在胎儿期可通过B超发现"双泡征"提前确诊,生后出现频繁的呕吐应想到本病的可能,30%泛影葡胺上消化道造影是简单易行的确诊方式,手术是治疗的关键,治疗及时者预后良好。

Pathogenesis and clinical significance of congenital duodenal obstruction in neonates

Objective:To summarize the pathogenesis and clinical characteristics of congenital duodenal obstruction in neonates,explore appropriate therapy,prognosis,and significance.Methods:Different surgical methods were used to treat different types of duodenal obstruction,the neonates with duodenal diaphragm were treated with diaphragm resection and transverse suture;the neonates with annular pancreas and duodenal atresia were treated with diamond anastomosis(upper transection and lower longitudinal cut);the neonates with intestinal malrotation were treated with Ladd surgery.Results:Among 32 neonates,30 neonates were cured and 2 neonates were dead,one neonate was found with cerebral palsy,the curative rate was 93.75%.Conclusion:Severe duodenal obstruction can be diagnosed definitely during fetal period by type B ultrasound characterized by " double-bubble sign",more attention should be paid to the neonates with frequent vomiting after birth,upper gastrointestinal tract examination with 30% gastrografin is a simple and easy method to diagnose duodenal obstruction definitely,surgery is the key of treatment,the neonates treated timely have good prognosis.