CAJ | 학술논문

目的探讨十二指肠梗阻的产前诊断、围产期管理与规范化治疗.方法本院与北京妇产医院合作建立了"先天性畸形产前诊断与围产期管理、生后治疗与随诊网络",2001年7月至2010年9月,按此网络模式进行管理与治疗且产前诊断为十二指肠梗阻患儿共44例.总结这44例患儿的产前诊断与生后治疗及预后情况.结果 44例孕妇在北京妇产医院产前常规超声检查诊断为胎儿十二指肠梗阻,来本院进行了咨询.咨询后3例选择引产,3例处于妊娠中,14例失访,24例经手术证实确诊并进行相应治疗.手术组24例产前超声征象中"双泡征"21例,羊水过多20例.出生后影像学检查:腹立位X线平片24例,其中22例显示"双泡征",1例"单泡征"、1例"三泡征";上消化道造影19例,均显示胃及十二指肠扩张、蠕动增强,十二指肠部位排空受阻;超声检查23例,10例显示十二指肠扩张、蠕动增强.手术方式:环状胰腺19例,均行十二指肠-十二指肠菱形吻合术;十二指肠膜式狭窄4例,行隔膜切除、肠管纵切横缝术;十二指肠离断式闭锁1例,行端-背肠吻合术;术中发现合并肠旋转不良11例,同时行Ladd手术治疗.手术患儿均治愈出院.结论对产前诊断为十二指肠梗阻的患儿应实施规范化围产期管理,出生后尽早手术治疗可取得较好的疗效.
목적 탐토십이지장경조적산전진단、위산기관리여규범화치료.방법본원여북경부산의원합작건립료"선천성기형산전진단여위산기관리、생후치료여수진망락",2001년7월지2010년9월,안차망락모식진행관리여치료차산전진단위십이지장경조환인공44례.총결저44례환인적산전진단여생후치료급예후정황.결과 44례잉부재북경부산의원산전상규초성검사진단위태인십이지장경조,래본원진행료자순.자순후3례선택인산,3례처우임신중,14례실방,24례경수술증실학진병진행상응치료.수술조24례산전초성정상중"쌍포정"21례,양수과다20례.출생후영상학검사:복립위X선평편24례,기중22례현시"쌍포정",1례"단포정"、1례"삼포정";상소화도조영19례,균현시위급십이지장확장、연동증강,십이지장부위배공수조;초성검사23례,10례현시십이지장확장、연동증강.수술방식:배상이선19례,균행십이지장-십이지장릉형문합술;십이지장막식협착4례,행격막절제、장관종절횡봉술;십이지장리단식폐쇄1례,행단-배장문합술;술중발현합병장선전불량11례,동시행Ladd수술치료.수술환인균치유출원.결론대산전진단위십이지장경조적환인응실시규범화위산기관리,출생후진조수술치료가취득교호적료효.
Objective To investigate the prenatal diagnosis, perinatal management and standardized treatment protocol for neonates with duodenal obstruction. Methods A "network in prenatal diagnosis, perinatal management and monitoring of congenital malformation" was founded between Beijing Obstetrics and Gynecology Hospital and the Capital Institute of Pediatrics. Forty-four fetuses were prenatally diagnosed as duodenal obstructions by this network from July,2001 to September, 2010. The data of prenatal diagnosis, treatment after birth and prognosis were analyzed. Results Among 44 patients diagnosed as fetal duodenal obstruction by prenatal ultrasonography, three cases underwent induced abortion, three were in pregnancy, 14 were lost during follow-up and 24 were confirmed by surgical treatments after birth. Within 24 neonates underwent surgery, 21 showed "double-bubble" sign and 20 combined with polyhydroamnios in prenatal ultrasonography. Twenty-four neonates underwent upright abdominal plain film examination,22 showed "double-bubble" sign, 1 showed "single-bubble" sign and 1 showed "triple-bubble" sign,respectively. Nineteen neonates underwent upper gastroenterography which showed distention of stomach and duodenum, increased stomach peristalsis and an obstacle of duodenum emptying. Within 23 neonates underwent ultrasonographic studies, 10 showed distention and increased peristalsis of duodenum. Following surgical procedures were performed: diamond shape anastomosis was completed in 19 cases with annular pancreas; duodenal vertical resection, across suture and excision of the membrane was done in four cases with duodenum membranate stenosis; end-to-back anastomosis was taken in one case with duodenal separate atresia; Ladd's procedure was applied in 11 cases associated with malrotation. All patients were cured. Conclusions Standardized perinatal management and earlier intervention should be offered to newborns with duodenal obstruction to achieve better effects.