St Peter Shawn D, Little Danny C, Barsness Katherine A, Copeland Daniel R, Calkins Casey M, Yoder Suzanne, Rothenberg Steve S, Islam Saleem, Tsao Kuojen, Ostlie Daniel J
Children's Mercy Hospital and Clinics, Kansas City, Missouri 64108, USA.
J Laparoendosc Adv Surg Tech A. 2010 Nov;20(9):773-5. doi: 10.1089/lap.2010.0173. Epub 2010 Aug 11.
During repair for duodenal atresia, it has been emphasized that inspection of the small bowel to identify a second atresia is required. The laparoscopic approach for repair of duodenal atresia has been criticized for its limitation to perform this step. Given that duodenal atresia and jejunoileal atresias do not share common embryologic origins, we question the validity of this concern. Therefore, we conducted a multicenter retrospective review of duodenal atresia patients to quantify the incidence of jejunoileal atresia in this population.
After institutional review board approval (IRB #07-12-187X), a retrospective review was conducted on all patients who have undergone duodenal atresia repair at seven institutions over the past 7-12 years. Demographics and the presence or absence of a jejunoileal atresia were recorded.
Four hundred eight patients with duodenal atresia were identified. The mean gestaational age was 36.3 ± 2.9 weeks, and the mean weight was 2.5 ± 0.8 kg. Mean age at operation was 19 days (range, 1-1314). There was a 28% incidence of trisomy 21. Two patients (0.5%) were identified as having a second intestinal atresia, and both were type IIIb. One patient was diagnosed at the time of duodenal atresia repair; the other was a delayed diagnosis. Both patients did well after repair.
In this, the largest series of duodenal atresia patients compiled to date, the rate of a concomitant jejunoileal atresia is less than 1%. This low incidence is not high enough to mandate extensive inspection of the entire bowel in these patients, and a second atresia should not be a concern during laparoscopic repair of duodenal atresia.
在十二指肠闭锁修复术中，一直强调需要检查小肠以确定是否存在第二处闭锁。十二指肠闭锁修复术的腹腔镜手术方法因在执行此步骤时存在局限性而受到批评。鉴于十二指肠闭锁和空回肠闭锁没有共同的胚胎学起源，我们对这种担忧的合理性提出质疑。因此，我们对十二指肠闭锁患者进行了多中心回顾性研究，以量化该人群中空回肠闭锁的发生率。
经机构审查委员会批准（IRB编号07 - 12 - 187X），对过去7至12年内在七家机构接受十二指肠闭锁修复术的所有患者进行回顾性研究。记录患者的人口统计学资料以及是否存在空回肠闭锁。
共确定408例十二指肠闭锁患者。平均孕周为36.3±2.9周，平均体重为2.5±0.8千克。平均手术年龄为19天（范围1 - 1314天）。21三体综合征的发生率为28%。两名患者（0.5%）被确定存在第二处肠道闭锁，均为IIIb型。一名患者在十二指肠闭锁修复时被诊断出；另一名为延迟诊断。两名患者修复后情况良好。
在迄今为止汇编的最大系列十二指肠闭锁患者中，合并空回肠闭锁的发生率低于1%。这种低发生率不足以要求对这些患者的整个肠道进行广泛检查，并且在十二指肠闭锁的腹腔镜修复术中不应担心存在第二处闭锁。
