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目的探讨新生儿肠闭锁(IA)的诊断、治疗与预后,以进一步提高治愈率。方法对本院2004年4月-2008年11月行手术治疗的29例先天性IA患儿临床资料进行回顾性分析。本组29例生后均有呕吐,15例有正常胎粪排出史,19例腹上区可见胃肠型,腹部立位平片示21例可见胃宽大液平面及数个扩张小肠液平、余8例仅见胃内的宽大液平,余部位无气体。术中见回肠闭锁16例,十二指肠闭锁7例,空肠闭锁6例;闭锁类型:Ⅰ型、Ⅱ型、Ⅲa型各9例,Ⅲb型(Apple-pee1)、Ⅳ型各1例;行IA近远端修剪端斜吻合术17例,IA隔膜切除纵切横缝术9例,IA近远端切除端端吻合术3例。术后29例均予全静脉营养支持。结果29例全部存活。其中治愈28例,1例术后放弃治疗。28例均未发现吻合口瘘及切口裂开等并发症。术后发生吻合口梗阻1例,经保守治疗后痊愈。26例术后获随访3个月～4 a,生长发育良好,无腹胀、腹痛。2例失访。结论早期诊断、合理的术式选择及围术期处理是提高IA治愈率的关键。
Objective To investigate the diagnosis, treatment and prognosis of neonatal intestinal atresia (IA) in order to further improve the cure rate. Methods The clinical data of 29 cases of congenital IA in our hospital from April 2004 to November 2008 were analyzed retrospectively. 29 cases of this group were vomited after birth, 15 cases of normal meconium discharge history, 19 cases of abdominal area can be seen in gastrointestinal type, abdominal plain film showed 21 cases of large stomach flat stomach and a few dilated intestinal fluid levels, The remaining 8 cases only see the stomach of the large liquid level, the remaining parts of no gas. In the operation, 16 cases were ileal atresia, 7 cases were duodenal atresia and 6 cases were jejunal atresia. There were 9 cases with type Ⅰ, Ⅱ and Ⅲa, 1 case with type Ⅲb (Apple-pee1) 17 cases of proximal and distal trimming anterior oblique anastomosis in IA, 9 cases of IA septum and longitudinal incision, and 3 cases of proximal and distal end resection and end anastomosis in IA. All patients were given total nourishment support after operation. Results All 29 patients survived. Among them, 28 cases were cured, one case gave up treatment after operation. 28 cases were found no anastomotic fistula and incision rupture and other complications. Anastomotic obstruction occurred in 1 case and was cured after conservative treatment. 26 patients were followed up for 3 months to 4 a, good growth and development, no bloating, abdominal pain. 2 cases were lost. Conclusion Early diagnosis, rational surgical selection and perioperative management are the keys to improve the cure rate of IA.