CAJ | 학술논문

目的总结小儿非梗阻性巨十二指肠症的临床特征及诊治体会.方法回顾2005年至2011年收治的4例非梗阻性巨十二指肠症的临床资料,对临床表现、影像学检查、治疗经过和预后情况进行分析.结果 4例患儿结合上消化道造影、B型超声检查和剖腹探查诊断为非梗阻性巨十二指肠症.例1和例2均行十二指肠裁剪成形、旷置并胃空肠Roux-en-Y吻合术;例3和例4行十二指肠裁剪成形、旷置并胃空肠端侧吻合术;同时例2和例3经十二指肠断端放置十二指肠引流管和经胃放置空肠营养管.4例均痊愈出院.术后十二指肠和交界处肠管病理均提示:黏膜固有层淋巴细胞浸润,肌层肥厚,肌纤维增生变性,肠壁肌间可见神经节细胞.术后随访4例患儿呕吐、腹泻和腹胀症状消失,体质量逐步增加.结论非梗阻性巨十二指肠症为病因不明的罕见疾病.B型超声和上消化道造影检查可提示十二指肠重度扩张,产前B型超声可发现.术式宜选用十二指肠裁剪成形、旷置术加胃空肠Roux-en-Y吻合术或胃空肠端侧吻合术,效果满意.
목적 총결소인비경조성거십이지장증적림상특정급진치체회.방법 회고2005년지2011년수치적4례비경조성거십이지장증적림상자료,대림상표현、영상학검사、치료경과화예후정황진행분석.결과 4례환인결합상소화도조영、B형초성검사화부복탐사진단위비경조성거십이지장증.례1화례2균행십이지장재전성형、광치병위공장Roux-en-Y문합술;례3화례4행십이지장재전성형、광치병위공장단측문합술;동시례2화례3경십이지장단단방치십이지장인류관화경위방치공장영양관.4례균전유출원.술후십이지장화교계처장관병리균제시:점막고유층림파세포침윤,기층비후,기섬유증생변성,장벽기간가견신경절세포.술후수방4례환인구토、복사화복창증상소실,체질량축보증가.결론 비경조성거십이지장증위병인불명적한견질병.B형초성화상소화도조영검사가제시십이지장중도확장,산전B형초성가발현.술식의선용십이지장재전성형、광치술가위공장Roux-en-Y문합술혹위공장단측문합술,효과만의.
Objective To explore the management strategies of idiopathic megaduodenum among children.Methods For 4 cases of megaduodenum at our hospital from 2005 to 2011,the clinical features,radiological data,treatment options,pathological findings and prognosis were retrospectively analyzed.And the relevant literatures were reviewed.Results The diagnosis of non-obstructive megaduodenum was confirmed by upper gastro-intestinal contrast study,ultrasonography and exploratory laparotomy.Cases 1 and 2 underwent tapering duodenoplasty with a proximal stump of duodenum divided & closed at pylorus and a Roux-en-Y gastrojejunostomy.And cases 3 and 4 had tapering duodenoplasty with proximal stump closure and an end-to-side gastrojejunostomy.On pathological examinations,all neural and vascular structures appeared normal.During the follow-up,diarrhea,bloating,vomiting and nausea disappeared and there was a rapid postoperative gain of body weight.Conclusions Idiopathic megaduodenum without organic obstruction is a rare clinical pediatric condition.Massive duodenal dilatation may be visualized distinctly by upper gastro-intestinal contrast study and antenatal ultrasonography.And satisfactory outcomes can be achieved by tapering duodenoplasty with proximal stump closure and gastrojejunostomy of either Roux-en-Y or end-to-side anastomosis.