Hu Shuqi, Han Yijiang, Chen Rui, Zhao Xiaoxia, Lai Dengming, Huang Shoujiang, Tou Jinfa, Du Lizhong
Department of Neonatal Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Department of Neonatology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Pediatr Surg Int. 2025 Jan 13;41(1):64. doi: 10.1007/s00383-025-05966-3.
To analyze the clinical characteristics and available treatment strategies for reoperation of neonatal high jejunal atresia, and recommend preventive measures to reduce the reoperation rate of high jejunal atresia.
The clinical data of 16 children with high jejunal atresia who underwent reoperation in the Neonatal Surgery Department at Children's Hospital of Zhejiang University School of Medicine from January 2018 to January 2023 were retrospectively analyzed.
Among the 16 unplanned reoperations, 7 (43.6%) were performed for functional ileus, 3 (18.8%) for anastomotic stenosis, 3 (18.8%) for adhesive ileus, and 3 (18.8%) for postoperative proximal septum. Surgical procedures for reoperations include duodenoplasty, resection and re-anastomosis of the original anastomosis, resection of the duodenal septum and enterolysis. Among the 16 patients, 1 had short-bowel syndrome that required repeated hospital admission for parenteral nutrition treatment, and 1 patient died of recurrent pneumonia and heart failure after surgery. The other 14 patients recovered from reoperation and were discharged. The patients were followed up from 1 month to 5 years after surgery, and showed good growth.
For children with high jejunal atresia, the operative procedure will vary according to each patient's circumstances. If postoperative functional obstruction occurs, a wider range of bowel cutting and re-anastomosis can be performed. During the first operation, the diaphragm at the proximal end of jejunal atresia should not be missed.
分析新生儿高位空肠闭锁再次手术的临床特点及可行的治疗策略，并推荐预防措施以降低高位空肠闭锁的再次手术率。
回顾性分析2018年1月至2023年1月在浙江大学医学院附属儿童医院新生儿外科接受再次手术的16例高位空肠闭锁患儿的临床资料。
在16例非计划性再次手术中，7例（43.6%）因功能性肠梗阻进行手术，3例（18.8%）因吻合口狭窄，3例（18.8%）因粘连性肠梗阻，3例（18.8%）因术后近端隔膜。再次手术的术式包括十二指肠成形术、原吻合口切除再吻合术、十二指肠隔膜切除术及肠粘连松解术。16例患者中，1例出现短肠综合征，需反复入院接受肠外营养治疗，1例患者术后因反复肺炎及心力衰竭死亡。其他14例患者再次手术后康复出院。术后对患者进行1个月至5年的随访，生长情况良好。
对于高位空肠闭锁患儿，手术方式需根据每个患者的具体情况而定。若术后发生功能性梗阻，可进行更广泛的肠切除及再吻合术。在首次手术时，不应遗漏空肠闭锁近端的隔膜。
