63例先天性十二指肠梗阻回顾性分析

发布时间：2018-06-26 11:19

本文选题：先天性十二指肠梗阻 + 诊治　；参考：《广西医科大学》2016年硕士论文

【摘要】：目的：总结先天性十二指肠梗阻(congenital duodenal obstruction CDO)的临床特点、早期诊断和治疗方法,探讨影响术后恢复及并发症发生的可能因素。方法：回顾性分析广西医科大学第一附属医院小儿外科2009年1月至2015年12月收住入院经手术治疗的63例CDO病例资料,采用卡方检验或确切概率法(T值1)比较发病年龄、临床症状、影像学表现不同,总结CDO临床特点及诊治情况。并分析病理类型、手术方式、术前呕吐情况、有无低钾或低钠电解质紊乱、有无白蛋白或血红蛋白下降、出生年龄、体重、孕周、评分、是否合并肺炎、有无合并肠道畸形与术后排便和进食时间的相关性,其中计量资料采用多重线性回归分析,计数资料采用方差分析,当P值0.05,差异有统计学意义,所有数据均由SPSS 22.0软件作统计处理。结果：(1)63例先天性十二指肠梗阻患儿中,肠旋转不良31例(49.2%),十二指肠闭锁或狭窄15例(23.8%),环状胰腺10例(15.87%),同时合并两种梗阻病变7例(11.11%),新生儿37例,婴儿11例,幼儿8例,儿童7例,有胆汁性呕吐43例(68.25%)。(2)腹部B超、上消化造影、CT、腹部平片诊断阳性率分别为61.53%(8/13)、92.85%(39/42)、75%(6/8)、57.14%(36/63),产前行B超7例,全部确诊,造成诊治时间延长的主要因素为未能及时有效地进一步影像学检查。本组均行手术治疗,62例获治愈(98.14%),1例死亡。术后并发症包括吻合口瘘(1例),粘连性肠梗阻(3例),切口感染(1例)。(3)肠旋转不良组术后排便、进食时间分别为3.03d、5.35d,比其他病理类型早(P分别为0.038、0.000),相应地行Ladd术病例术后进食时间比其他手术方式早(p=0.019),术前无呕吐进食时间为5.6d,较术前有呕吐要早(p=0.046),术前无合并肺炎时排便时间更早(p=0.005),术前无合并低钾或低钠较合并者进食及排便时间均较早(p=0.013),术前无合并低白蛋白或低血红蛋白较合并时的进食、排便时间早(p分别为0.009、0.036)。结论：(1)先天性十二指肠梗阻以新生儿好发,随年龄增大发病率降低,最常见病因为肠旋转不良。(2)产前B超的普及以及对胆汁性呕吐患儿尽早行上消化道造影等进一步检查可更早明确诊断。(3)应根据不同病理类型合理选择手术、加强围术期处理、纠正水电解质紊乱、贫血及低蛋白血症、积极治疗肺炎以利于术后恢复并可减少术后并发症发生。
[Abstract]:Objective: to summarize the clinical features, early diagnosis and treatment of (congenital duodenal obstruction in congenital duodenal obstruction, and to explore the possible factors affecting postoperative recovery and complications. Methods: the data of 63 cases of CDO admitted to hospital from January 2009 to December 2015 in pediatric surgery of the first affiliated Hospital of Guangxi Medical University were analyzed retrospectively. The age of CDO was compared by chi-square test or exact probability method (T value 1). Clinical symptoms and imaging manifestations were different. The clinical features and diagnosis and treatment of CDO were summarized. The pathological types, surgical methods, preoperative vomiting, disturbance of hypokalemia or hyponatremia, decrease of albumin or hemoglobin, birth age, body weight, gestational week, score, pneumonia or not were analyzed. The correlation between bowel malformation and postoperative defecation and feeding time was observed. The quantitative data were analyzed by multiple linear regression analysis, and the count data by ANOVA. When P value was 0.05, the difference was statistically significant. All the data were processed by SPSS 22.0 software. Results: (1) among 63 children with congenital duodenal obstruction, 31 cases (49.2%) had intestinal malrotation, 15 cases (23.8%) had duodenal atresia or stenosis, 10 cases (15.87%) had annular pancreas, 7 cases (11.11%) were complicated with two kinds of obstruction, 37 cases were newborns, 11 cases were infants, 8 cases were infants. Among the 7 children, 43 cases (68.25%). (2) had bile vomiting. The positive rate of abdominal plain film diagnosis was 61.53% (8 / 13), 92.85% (39 / 42) and 75% (6 / 8) or 57.14% (36 / 63), respectively. The main reason for prolonging the diagnosis and treatment time was the failure to make further imaging examination in time and effectively. 62 cases were cured (98.14%) and 1 case died. Postoperative complications included anastomotic fistula (1 case), adhesive intestinal obstruction (3 cases) and incision infection (1 case). (3). The feeding time was 3.03 days and 5.35 days, which was earlier than that of other pathological types (P = 0.038, 0.000, respectively). The postoperative feeding time of patients with Ladd was earlier than that of other surgical methods (p0.019). The time of eating without vomiting before operation was 5.6 days, which was earlier than that with vomiting before operation (p0.046). The time of defecation was earlier (p0. 005). The time of eating and defecating without hypokalemia or hyponatremia was earlier (p0. 013) than that of patients without hypokalemia or hyponatremia (p0. 013). The time of defecation was earlier (p = 0.009 ~ 0.036). Conclusion: (1) congenital duodenal obstruction is common in newborns, and the incidence of congenital duodenal obstruction decreases with age. The most common disease is intestinal malrotation. (2) the popularization of prenatal B-mode ultrasound and the early examination of upper digestive tract examination in children with bile vomiting can make a definite diagnosis earlier. (3) the operation should be reasonably selected according to different pathological types, and the perioperative management should be strengthened. Correct water and electrolyte disorders, anemia and hypoproteinemia, actively treat pneumonia to facilitate postoperative recovery and reduce postoperative complications.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R726.5

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