Miller R C
Ann Surg. 1979 May;189(5):607-11. doi: 10.1097/00000658-197905000-00010.
In this group of 45 intestinal atresia patients (duodenum, 16; jejunum, 24; ileum five) at the University of Mississippi Medical Center, individual hospitalizations ranged up to 245 days. Twelve patients required multiple operations, and the overall mortality rate was 22% (ten patients). While the patients with duodenal atresia had the greatest incidence of other congenital anomalies, including Down's syndrome, the patients with jejunal atresia presented with the most challenging surgical problems. Of the 24 jejunal atresia patients, only three had a single, simple area of obstruction. The remainder were complicated by other gastrointestinal lesions (five patients), by multiple areas of atresia (seven patients) including those in one surviving patient with 22 separate atretic segments, and by the Christmas tree deformity (nine patients). Intraoperative management of the complicated atresia should include: 1) grouping of multiple atresias during resection, 2) adequate resection of the dilated proximal atonic loop, 3) end-to-end anastomoses, 4) avoidance of intraluminal catheters, 5) additional resection of a segment of the distal loop in the Christmas tree deformity and 6) consideration of the shish kebab technique for multiple atretic webs. Postoperative management should involve early intravenous nutrition and repeated exploration for continued obstruction.
在密西西比大学医学中心的这组45例肠闭锁患者中（十二指肠闭锁16例；空肠闭锁24例；回肠闭锁5例），个体住院时间长达245天。12例患者需要多次手术，总体死亡率为22%（10例患者）。虽然十二指肠闭锁患者合并其他先天性异常（包括唐氏综合征）的发生率最高，但空肠闭锁患者面临的手术问题最具挑战性。在24例空肠闭锁患者中，只有3例存在单一、简单的梗阻部位。其余患者则合并其他胃肠道病变（5例）、多处闭锁（7例），其中1例存活患者有22个独立闭锁段，还有圣诞树畸形（9例）。复杂闭锁的术中处理应包括：1）切除时将多处闭锁进行分组；2）充分切除扩张的近端无张力肠袢；3）端端吻合；4）避免使用腔内导管；5）对圣诞树畸形患者额外切除一段远端肠袢；6）考虑对多个闭锁膜采用串烤技术。术后处理应包括早期静脉营养支持以及对持续梗阻进行反复探查。
