Wu P Q, Chen P Y, Ren L, Xiong L Y, Li H W, Gong S T, Wu Q, Chai C W, Geng L L
Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou 510623, China.
Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou 510623, China.
Zhonghua Er Ke Za Zhi. 2023 Jul 2;61(7):614-619. doi: 10.3760/cma.j.cn112140-20230417-00275.
To explore the efficacy and safety of endoscopic diaphragm incision in pediatric congenital duodenal diaphragm. Eight children with duodenal diaphragm treated by endoscopic diaphragm incision in the Department of Gastroenterology of Guangzhou Women and Children's Medical Center from October 2019 to May 2022 were enrolled in this study. Their clinical data including general conditions, clinical manifestations, laboratory and imaging examinations, endoscopic procedures and outcomes were retrospectively analyzed. Among the 8 children, 4 were males and 4 females. The diagnosis was confirmed at the age of 6-20 months; the age of onset was 0-12 months and the course of disease was 6-18 months. The main clinical manifestations were recurrent non-biliary vomiting, abdominal distension and malnutrition. One case complicated with refractory hyponatremia was first diagnosed with atypical congenital adrenal hyperplasia in the endocrinology department. After treatment with hydrocortisone, the blood sodium returned to normal, but vomiting was recurrent. One patient underwent laparoscopic rhomboid duodenal anastomosis in another hospital but had recurred vomiting after the operation, who was diagnosed with double duodenal diaphragm under endoscope. No other malformations were found in all the 8 cases. The duodenal diaphragm was located in the descending part of the duodenum, and the duodenal papilla was located below the diaphragm in all the 8 cases. Three cases had the diaphragm dilated by balloon to explore the diaphragm opening range before diaphragm incision; the other 5 had diaphragm incision performed after probing the diaphragm opening with guide wire. All the 8 cases were successfully treated by endoscopic incision of duodenal diaphragm, with the operation time of 12-30 minutes. There were no complications such as intestinal perforation, active bleeding or duodenal papilla injury. At one month of follow-up, their weight increased by 0.4-1.5 kg, with an increase of 5%-20%. Within the postoperative follow-up period of 2-20 months, all the 8 children had duodenal obstruction relieved, without vomiting or abdominal distension, and all resumed normal feeding. Gastroscopy reviewed at 2-3 months after the operation in 3 cases found no deformation of the duodenal bulbar cavity, and the mucosa of the incision was smooth, with a duodenal diameter of 6-7 mm. Endoscopic diaphragm incision is safe, effective and less invasive in pediatric congenital duodenal diaphragm, with favorable clinical applicability.
探讨内镜下十二指肠隔膜切开术治疗小儿先天性十二指肠隔膜的疗效及安全性。选取2019年10月至2022年5月在广州市妇女儿童医疗中心消化内科接受内镜下十二指肠隔膜切开术治疗的8例十二指肠隔膜患儿进行研究。回顾性分析其临床资料，包括一般情况、临床表现、实验室及影像学检查、内镜操作及治疗效果等。8例患儿中，男4例，女4例。确诊年龄为6～20个月；发病年龄为0～12个月，病程为6～18个月。主要临床表现为反复非胆汁性呕吐、腹胀及营养不良。1例合并难治性低钠血症患儿最初在内分泌科被诊断为非典型先天性肾上腺皮质增生症。经氢化可的松治疗后血钠恢复正常，但仍反复呕吐。1例患儿在其他医院行腹腔镜菱形十二指肠吻合术，术后仍反复呕吐，经内镜检查诊断为双十二指肠隔膜。8例患儿均未发现其他畸形。十二指肠隔膜均位于十二指肠降部，8例患儿十二指肠乳头均位于隔膜下方。3例在隔膜切开术前用球囊扩张隔膜以探查隔膜开口范围；另外5例用导丝探查隔膜开口后行隔膜切开术。8例患儿均经内镜十二指肠隔膜切开术成功治疗，手术时间为12～30分钟。无肠穿孔、活动性出血或十二指肠乳头损伤等并发症。随访1个月时，体重增加0.4～1.5 kg，增幅为5%～20%。术后2～20个月的随访期内，8例患儿十二指肠梗阻均解除，无呕吐及腹胀，均恢复正常喂养。3例患儿术后2～3个月复查胃镜，十二指肠球部腔无变形，切口黏膜光滑，十二指肠直径为6～7 mm。内镜下十二指肠隔膜切开术治疗小儿先天性十二指肠隔膜安全、有效，创伤小，具有良好的临床应用价值。
