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目的探讨提高新生儿先天性十二指肠梗阻治愈率的方法。方法总结近8年收治的66例新生儿先天性十二指肠梗阻的临床资料。对术前诊断、病理类型、手术时机、手术方法及围手术期管理进行回顾性分析。结果 66例患儿均于术前行直立位腹平片及上消化道泛影葡胺造影检查,17例行泛影葡胺下消化道造影检查。所有患儿均行手术治疗,其中十二指肠闭锁及狭窄4例,环状胰腺18例,十二指肠膈膜7例,单纯肠旋转不良15例,复合型18例,全小肠扭转4例,其中2例因全小肠坏死死亡,术后有2例患儿因先天愚型,家人放弃进一步治疗,余62例患儿均痊愈出院,治愈率达94%。结论术前X线检查是诊断先天性十二指肠梗阻最有效,早期诊断,合理选择手术时机及手术方法,注意合并病变,避免漏诊,加强围手术期管理是提高治愈率的关键。
Objective To explore ways to improve the cure rate of neonatal congenital duodenal obstruction. Methods The clinical data of 66 cases of congenital duodenal obstruction admitted in recent 8 years were summarized. Preoperative diagnosis, pathological types, timing of surgery, surgical methods and perioperative management were retrospectively analyzed. Results 66 cases of children underwent orthostatic abdominal plain film and upper gastrointestinal megluminemethrin before angiography, 17 cases underwent diatrizoanthropoiesis. All children underwent surgery, including duodenal atresia and stenosis in 4 cases, 18 cases of annular pancreas, duodenal diaphragm in 7 cases, simple bowel dysfunction in 15 cases, complex type in 18 cases, the whole intestine was reversed 4 Cases, of which 2 cases died of total small intestine necrosis, 2 patients after surgery due to Down’s syndrome, the family abandoned further treatment, more than 62 cases of children were discharged, the cure rate was 94%. Conclusion Preoperative X-ray examination is the most effective and early diagnosis of congenital duodenal obstruction. It is a reasonable choice of operation timing and operation method. Pay attention to the merger of lesions and avoid misdiagnosis. Strengthening perioperative management is the key to improve the cure rate.