本文選題：先天性十二指腸梗阻 + 診治��； 參考：《廣西醫(yī)科大學》2016年碩士論文

【摘要】：目的：總結先天性十二指腸梗阻(congenital duodenal obstruction CDO)的臨床特點、早期診斷和治療方法,探討影響術后恢復及并發(fā)癥發(fā)生的可能因素。方法：回顧性分析廣西醫(yī)科大學第一附屬醫(yī)院小兒外科2009年1月至2015年12月收住入院經(jīng)手術治療的63例CDO病例資料,采用卡方檢驗或確切概率法(T值1)比較發(fā)病年齡、臨床癥狀、影像學表現(xiàn)不同,總結CDO臨床特點及診治情況。并分析病理類型、手術方式、術前嘔吐情況、有無低鉀或低鈉電解質紊亂、有無白蛋白或血紅蛋白下降、出生年齡、體重、孕周、評分、是否合并肺炎、有無合并腸道畸形與術后排便和進食時間的相關性,其中計量資料采用多重線性回歸分析,計數(shù)資料采用方差分析,當P值0.05,差異有統(tǒng)計學意義,所有數(shù)據(jù)均由SPSS 22.0軟件作統(tǒng)計處理。結果：(1)63例先天性十二指腸梗阻患兒中,腸旋轉不良31例(49.2%),十二指腸閉鎖或狹窄15例(23.8%),環(huán)狀胰腺10例(15.87%),同時合并兩種梗阻病變7例(11.11%),新生兒37例,嬰兒11例,幼兒8例,兒童7例,有膽汁性嘔吐43例(68.25%)。(2)腹部B超、上消化造影、CT、腹部平片診斷陽性率分別為61.53%(8/13)、92.85%(39/42)、75%(6/8)、57.14%(36/63),產(chǎn)前行B超7例,全部確診,造成診治時間延長的主要因素為未能及時有效地進一步影像學檢查。本組均行手術治療,62例獲治愈(98.14%),1例死亡。術后并發(fā)癥包括吻合口瘺(1例),粘連性腸梗阻(3例),切口感染(1例)。(3)腸旋轉不良組術后排便、進食時間分別為3.03d、5.35d,比其他病理類型早(P分別為0.038、0.000),相應地行Ladd術病例術后進食時間比其他手術方式早(p=0.019),術前無嘔吐進食時間為5.6d,較術前有嘔吐要早(p=0.046),術前無合并肺炎時排便時間更早(p=0.005),術前無合并低鉀或低鈉較合并者進食及排便時間均較早(p=0.013),術前無合并低白蛋白或低血紅蛋白較合并時的進食、排便時間早(p分別為0.009、0.036)。結論：(1)先天性十二指腸梗阻以新生兒好發(fā),隨年齡增大發(fā)病率降低,最常見病因為腸旋轉不良。(2)產(chǎn)前B超的普及以及對膽汁性嘔吐患兒盡早行上消化道造影等進一步檢查可更早明確診斷。(3)應根據(jù)不同病理類型合理選擇手術、加強圍術期處理、糾正水電解質紊亂、貧血及低蛋白血癥、積極治療肺炎以利于術后恢復并可減少術后并發(fā)癥發(fā)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.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R726.5

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