Dewberry Lindel C, Hilton Sarah A, Vuille-Dit-Bille Raphael N, Liechty Kenneth W
Department of Surgery, University of Colorado, Denver, CO, United States.
Department of Surgery, Kantonsspital Winterthur, Winterthur, Switzerland.
J Int Med Res. 2020 Jan;48(1):300060519862109. doi: 10.1177/0300060519862109. Epub 2019 Jul 29.
Congenital duodenal obstruction is typically treated by duodenoduodenostomy. Tapering of the dilated segment has been indicated to reduce duodenal dysmotility. The purpose of this study was to review the outcomes between these two approaches.
We retrospectively reviewed cases of duodenal obstruction repair performed at a quaternary care referral pediatric hospital from 2007 to 2017. The length of stay, time to full enteral feeding, and complications were compared between patients who underwent duodenoduodenostomy with and without tapering duodenoplasty (n=4 and n=35, respectively).
Both groups had similar times to initial enteral feeding (7 days) and full enteral feeding (14 vs. 15 days). Among the 35 patients who underwent duodenoduodenostomy alone, 6 (17%) required a return to the operating room; in contrast, no patients who underwent tapering required a return to the operating room. Of those who returned to the operating room, two underwent tapering at that time because of duodenal dilation and feeding intolerance.
Although limited by the small sample size, this study suggests that patients undergoing tapering duodenoplasty may have a slightly shorter time to full enteral feeding and a lower rate of complications than patients undergoing duodenoduodenostomy alone.
先天性十二指肠梗阻通常采用十二指肠十二指肠吻合术治疗。已表明对扩张段进行缩窄可减少十二指肠运动障碍。本研究的目的是比较这两种方法的治疗效果。
我们回顾性分析了2007年至2017年在一家四级医疗转诊儿科医院进行的十二指肠梗阻修复病例。比较了接受十二指肠十二指肠吻合术且未进行十二指肠成形术缩窄（分别为n = 4和n = 35）的患者之间的住院时间、完全肠内喂养时间和并发症情况。
两组患者开始肠内喂养的时间（7天）和完全肠内喂养的时间（14天对15天）相似。在仅接受十二指肠十二指肠吻合术的35例患者中，有6例（17%）需要再次手术；相比之下，接受缩窄手术的患者均无需再次手术。在那些返回手术室的患者中，有2例因十二指肠扩张和喂养不耐受而在那时进行了缩窄手术。
尽管本研究受样本量小的限制，但提示接受十二指肠成形术缩窄的患者完全肠内喂养的时间可能略短，且并发症发生率低于仅接受十二指肠十二指肠吻合术的患者。
