V型瓣菱形吻合法治疗新生儿环状胰腺的临床研究

南方医科大学附属广东省佛山市妇幼保健院(广东省佛山市,528000),1.新生儿外科,2.新生儿科,Email:Tanghuajian@126.com

胰腺; 肠梗阻; 外科手术; 婴儿,新生

Efficacies of modified diamond-shaped anastomosis for neonatal annular pancreas.
Tang Huajian1,Zheng Jintao1,Li Weiliao1,Huang Zhenqiang1,Yu Zhi1,Liu Guoqing1,Liu Weidong2.

1.Department of Pediatric Surgery; 2.Department of Neonatology,Affiliated Municipal Women & Children's Health Hospital,Nanfang Medical University,Foshan 528000,China.Email:tanghuajian@163.com

Pancreas; Intestinal Obstruction; Surgical Procedures,Operative; Infant,Newborn

DOI: 10.3969/j.issn.1671— 6353.2018.07.015

备注

目的 探讨改良V型瓣十二指肠菱形吻合法治疗新生儿环状胰腺的临床效果。方法 回顾性分析本院新生儿外科2011年1月至2016年10月收治的19例环状胰腺患儿临床资料,其中男性11例,女性8例; 早产儿6例,足月儿13例。体重1 760~3 675 g,平均体重2 785 g。胎儿期超声检查发现双泡征13例。19例出生后均经上消化道造影检查提示十二指肠降部梗阻。10 例行下消化道造影检查,其中7例排除肠旋转不良,4例结肠纤细。术前合并休克2例,急性肾功能衰竭1例,电解质紊乱11例,上消化道出血5例,吸入性肺炎7例。1例多发畸形,合并肛门闭锁、房间隔缺损、肺发育不良。手术方法均采用改良十二指肠菱形吻合术,于十二指肠近端横向V形切开,远端纵行切开,切口约2 cm。用5-0 VICRYL吸收线单层吻合。结果 手术时间56~168 min,平均(87±35)min。术中出血3~15 mL,平均(6±5)mL,无一例输血。禁食时间(5~10)d,平均(7±3)d。住院时间(3~48)d,平均(19±14)d。术后出现切口感染1例。术中发现环状胰腺合并十二指肠隔膜闭锁6例。1例合并十二指肠闭锁、肠旋转不良、肠粘连、肛门闭锁术后第2天家属放弃治疗; 其余18例术后12~14 d经上消化道造影提示吻合口通畅,无狭窄,无吻合口瘘,痊愈出院。结论 环状胰腺是一种罕见的新生儿消化道畸形,及时治疗能获得满意的治疗效果。十二指肠菱形吻合术是首选治疗方法,改良吻合口设计,行V形切开吻合,可有效减少吻合口张力,对防止吻合口狭窄、吻合口瘘的发生有一定意义。合并多发畸形是影响该病预后的主要危险因素。
Objective To explore the efficacies of modified diamond-shaped anastomosis for annular pancreas in newborns. Methods Retrospective analyses were performed for the clinical data of 19 newborns with annular pancreas during January 2011 to October 2016.There were 11 boys and 8 girls.They were premature(n=6)and full-term(n=13).The average weight was 2 785(1 760~3 675)grams.Prenatal ultrasound revealed a double bubble sign in 13 cases.Upper gastrointestinal iodized oil angiography detected duodenal obstruction in all of them.Lower digestive tract contrast examination were performed in 10 cases.And 7/10 cases eliminated intestinal malrotation and 4/10 micro-colon.One case had multiple malformations with anal atresia,atrial septal defect and congenital pulmonary hypoplasia.Modified diamond-shaped anastomosis was performed.Dilated proximal duodenum was dissected in a transverse v-shaped incision and distal micro-duodenum accessed longitudinally for 2 cm. Results The average surgical duration was(87±35)(56~168)min and the average intraoperative bleeding volume(6±5)(3~15)mL.There was no blood transfusion.The average postoperative fasting lasted(7±3)(5~10)days.And the average hospitalization stay was(19±14)(3~48)days.There was 1 case of incision infection.Another case of multiple malformations was abandoned by his parents at Day 1 post-operation.The remainder recovered.Postoperative upper gastrointestinal angiography at Day 12~14 showed no anastomotic stenosis or fistula. Conclusion Annular pancreas is not a common neonatal gastrointestinal tract malformation and diamond-shaped anastomosis is a major therapy.Modified diamond-shaped anastomosis has excellent outcomes.It may enlarge anastomosis and reduce anastomotic tension so as to prevent the occurrence of anastomotic stenosis and fistula.Multiple malformations are the major prognostic factors.