Gupta Shilpi, Gupta Rahul, Ghosh Soumyodhriti, Gupta Arun Kumar, Shukla Arvind, Chaturvedi Vinita, Mathur Praveen
Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India.
J Neonatal Surg. 2016 Oct 10;5(4):51. doi: 10.21699/jns.v5i4.405. eCollection 2016 Oct-Dec.
To evaluate the presentation, management, complications and outcome of intestinal atresia (IA) managed at our center over a period of 1 year. Records of patients of IA admitted in our center from January 2015 to December 2015 were retrospectively analyzed. Demographic data, antenatal history, presenting complaints, location (duodenal, jejunoileal, colonic) of atresia, surgery performed and peri-operative complications were noted. Total 78 cases of IA were included in the analyses. Mean age and weight at the time of presentation was 5.8 days (range 0-50), and 1.9 kg (range 1.1-3.2), respectively. IA included duodenal atresia [DA (32)], jejuno-ileal atresia [JIA (40)], colonic atresia [CA (3)] and atresia at multiple-location (sites) in 3 cases. Ninety percent of patients underwent surgery within 5 to 20 hours of admission. All cases of DA except one underwent Kimura's diamond shaped duodeno-duodenostomy. One case with perforated duodenal web underwent duodenotomy with excision of web. Seven patients with JIA and CA required primary stoma, while rest were managed by excision of dilated proximal segment and primary anastomosis. Complications included anastomotic leak in 5, proximal perforation in 2, functional obstruction in 7, aspiration pneumonitis in 3, and wound infection in 6 patients. Mean hospital stay for survivors was 11 days. Overall survival was 63%. Late presentation, overcrowding in intensive care unit, septicemia, functional obstruction and anastomotic leak are the causes of poor outcome in our series. Early diagnosis, some modification in surgical technique, use of total parenteral nutrition and adequate investigations for other congenital anomalies may improve the outcome.
评估我院中心在1年时间内对肠闭锁（IA）的诊治情况、并发症及治疗结果。对2015年1月至2015年12月我院中心收治的IA患者记录进行回顾性分析。记录人口统计学数据、产前病史、就诊主诉、闭锁部位（十二指肠、空回肠、结肠）、所行手术及围手术期并发症。分析共纳入78例IA患者。就诊时的平均年龄和体重分别为5.8天（范围0 - 50天）和1.9千克（范围1.1 - 3.2千克）。IA包括十二指肠闭锁[DA（32例）]、空回肠闭锁[JIA（40例）]、结肠闭锁[CA（3例）]以及3例多部位闭锁。90%的患者在入院后5至20小时内接受手术。除1例DA患者外，所有DA病例均行木村菱形十二指肠 - 十二指肠吻合术。1例十二指肠膜状闭锁穿孔患者行十二指肠切开术并切除隔膜。7例JIA和CA患者需要行一期造口术，其余患者通过切除扩张的近端肠段并进行一期吻合术治疗。并发症包括5例吻合口漏、2例近端穿孔、7例功能性肠梗阻、3例吸入性肺炎和6例伤口感染。存活患者的平均住院时间为11天。总体生存率为63%。就诊延迟、重症监护病房拥挤、败血症、功能性肠梗阻和吻合口漏是我们系列研究中预后不良的原因。早期诊断、手术技术的一些改进、全胃肠外营养的使用以及对其他先天性异常进行充分检查可能会改善预后。
