背景:肠闭锁是新生儿肠梗阻的常见原因。闭锁常与其他先天性异常有关。这项研究的目的是评估相关的异常,操作管理,以及肠闭锁婴儿的术后结局。
方法:对2012年3月至2022年2月到一家独立儿童医院就诊的患者进行了回顾。检查的变量是闭锁类型,额外的先天性异常,手术干预的类型,和术后结果。使用标准统计方法。
结果:共发现75例肠闭锁患者,其中一些患者患有多发性闭锁。孤立性十二指肠闭锁患者最常见(49.3%),其次是空肠(32%)和回肠(12%)。混合闭锁罕见,为4%,孤立的幽门和结肠也很少见,各占1.3%。旋转不良与13%的患者相关,与十二指肠和空肠闭锁同等相关。与胃裂和伴随的旋转不良相结合,发现肠闭锁的百分比较低(3%)。大多数十二指肠闭锁的婴儿接受了标准的十二指肠十二指肠造口术(19%的腹腔镜手术,81%开放)。在空肠闭锁的婴儿中,大多数进行了切除和原发性吻合术。渐缩的肠成形术主要在13%的闭锁中进行。在进行和未进行渐缩肠成形术的人之间,首次进食时间或停留时间没有显着差异。11%的患者需要对狭窄或小肠梗阻进行后续干预。在这个系列中有一个死亡。
结论:与其他文献一致,十二指肠闭锁是最常见的肠闭锁类型。然而,我们证明旋转不良与十二指肠和空肠闭锁同样相关,而之前的报告显示与十二指肠闭锁的相关性更高.在我们的患者群体中,渐缩小肠成形术的使用似乎与结局无关.总的来说,这些婴儿的发病率和死亡率低,很少需要再次手术。
BACKGROUND: Intestinal
atresia is a common cause of neonatal bowel obstruction. Atresias are often associated with other congenital anomalies. The purpose of the study was to evaluate associated anomalies, operative management, and postoperative outcomes of infants with intestinal
atresia.
METHODS: A review of patients presenting to a single free-standing children\'s hospital from March 2012 through February 2022 was performed. The variables examined were type of atresia, additional congenital anomalies, type of operative intervention, and postoperative outcomes. Standard statistical methods were utilized.
RESULTS: A total of 75 patients with intestinal
atresia were identified and several of these patients had multiple atresias. Isolated duodenal
atresia patients were the most common (49.3%), followed by jejunal (32%) and ileal (12%). Mixed atresias were rare at 4%, with isolated pyloric and colonic also rare at 1.3% each. Malrotation was associated with 13% of patients and equally associated with duodenal and jejunoileal atresias. A low percentage (3%) of intestinal atresias was seen in conjunction with gastroschisis and concomitant malrotation. A majority of infants with duodenal atresia underwent standard duodenoduodenostomy (19% laparoscopic, 81% open). In infants with jejunoileal
atresia, most underwent resection with primary anastomosis. A tapering enteroplasty was performed primarily in 13% of atresias. There were no significant differences noted in time to first feed or length of stay between those with and without tapering enteroplasty. Eleven percent of patients required subsequent intervention for stricture or small bowel obstruction. There was one death in this series.
CONCLUSIONS: Consistent with other literature, duodenal atresia was the most common type of intestinal
atresia. However, we demonstrated that malrotation was equally associated with duodenal and jejunoileal atresias while prior reports had shown a higher association with duodenal atresia. In our patient population, the use of tapering enteroplasty did not appear to be associated with outcomes. Overall, these infants have a low morbidity and mortality rate with a rare need for reoperation.