Miscia Maria Enrica, Lauriti Giuseppe, Lelli Chiesa Pierluigi, Zani Augusto
Division of General and Thoracic Surgery, The Hospital for Sick Children, 1524C-555 University Ave, Toronto, ON, M5G 1X8, Canada.
Department of Pediatric Surgery, "Spirito Santo" Hospital, Pescara, Italy.
Pediatr Surg Int. 2019 Jan;35(1):151-157. doi: 10.1007/s00383-018-4387-1. Epub 2018 Nov 1.
To determine the true incidence of associated intestinal atresia (AIA) in infants with duodenal atresia (DA) and to analyze whether the surgical approach, open versus laparoscopic, would impact on patient outcome when AIA is present.
Cohort study We review all DA infants treated at our institution (2001-2016) and analyzed the outcome of those with AIA. Systematic review/meta-analysis Using a defined search strategy and according to PRISMA guidelines, two investigators independently identified all studies on DA and searched cases of AIA to determine its incidence. Data are mean ± SD.
Cohort study Of 140 DA infants, 10 (7%) had AIA (4 type I, 4 type III, 2 type II). All type I AIA (webs) were found in the duodenum. Systematic review/meta-analysis Of 840 studies, 18 were included (2026 infants). The incidence of AIA was 2.8 ± 1.6%. The incidence of missed AIA was 0.8 ± 2.4%. Three comparative studies (759 infants) showed higher risk of missed AIA following laparoscopic (2.9 ± 2.4%) than open repair (0.3 ± 0.1%; p < 0.01).
The incidence of AIA in DA infants is low and the risk of missing it is higher at laparoscopy than at laparotomy. Regardless the approach, surgeons should carefully investigate bowel continuity to avoid the risk of missing AIA.
确定十二指肠闭锁（DA）婴儿中合并肠道闭锁（AIA）的真实发病率，并分析当存在AIA时，开放手术与腹腔镜手术这两种手术方式是否会影响患者的预后。
队列研究。我们回顾了在我院接受治疗的所有DA婴儿（2001 - 2016年），并分析了合并AIA的婴儿的预后情况。系统评价/荟萃分析。使用既定的检索策略并根据PRISMA指南，两名研究人员独立识别所有关于DA的研究，并搜索AIA病例以确定其发病率。数据以均值±标准差表示。
队列研究。在140例DA婴儿中，10例（7%）合并AIA（4例I型，4例III型，2例II型）。所有I型AIA（隔膜）均在十二指肠中发现。系统评价/荟萃分析。在840项研究中，纳入了18项（2026例婴儿）。AIA的发病率为2.8±1.6%。漏诊AIA的发病率为0.8±2.4%。三项比较研究（759例婴儿）显示，腹腔镜手术后漏诊AIA的风险（2.9±2.4%）高于开放修复（0.3±0.1%；p<0.01）。
DA婴儿中AIA的发病率较低，腹腔镜检查时漏诊的风险高于剖腹手术。无论采用何种手术方式，外科医生都应仔细检查肠道连续性，以避免漏诊AIA的风险。
