Doletskiĭ S Ia, Arapova A V, Zagudaev S A, Reznikova A E
Khirurgiia (Mosk). 1994 Aug(8):25-7.
The article deals with 5-year (1986-1992) experience in the diagnosis and treatment of duodenal atresia in 26 infants. Timely diagnosis of this developmental anomaly, the variants of operative treatment, and the principles of postoperative management are discussed. The necessity of antenatal ultrasonic examination and the high diagnostic value of radiological and endoscopic methods of diagnosis are emphasized. Operations were conducted on 25 children for total high intestinal obstruction, on 23 infants in the neonatal period. The continuity of the intestinal tube was restored by duodenoduodenostomy (12), duodenojejunostomy (3), gastroduodenostomy (1), excision of the membrane (4), and dissection of the membrane (5). The latter is technically the simplest and is the operation of choice. Preliminary jejunostomy for adequate preparation for the radical operation is recommended in profoundly preterm infants with as serious premorbid background. Of high importance is postoperative enteral catheteral feeding which is begun from the first day after the operation. Seven out of the 26 patients died from severe combined developmental anomalies and infection. The mortality was 26.9%.
本文介绍了对26例婴儿十二指肠闭锁的5年（1986 - 1992年）诊断和治疗经验。讨论了这种发育异常的及时诊断、手术治疗的方式以及术后管理原则。强调了产前超声检查的必要性以及放射学和内镜诊断方法的高诊断价值。25例儿童因完全性高位肠梗阻接受手术，其中23例为新生儿期婴儿。通过十二指肠十二指肠吻合术（12例）、十二指肠空肠吻合术（3例）、胃十二指肠吻合术（1例）、隔膜切除术（4例）和隔膜切开术（5例）恢复肠管连续性。后者在技术上最简单，是首选的手术方式。对于有严重合并症背景的极低出生体重早产儿，建议先行空肠造口术以充分准备根治性手术。术后肠内导管喂养非常重要，术后第一天即开始。26例患者中有7例死于严重的合并发育异常和感染。死亡率为26.9%。
