Abstract：Objective: To determine whether diaphragmectomy or diamond-shaped anastomosis is the more effective treatment in infants with perforate duodenal diaphragm. Methods: Seventy-two infants with congenital duodenal diaphragm were divided into neonatal group(<30 d), younger infant group(30-60 d) and elder infant group(≥60 d). Each age group were divided into diaphragmectomy group and diamond-shaped anastomosis group according to the operation approach. Duration of operation, functional recovery time of alimentary canal, total enteral nutrition, postoperative hospital stay, body weight in 2 months and 6 months after surgery, postoperative incidence of obstructive jaundice, postoperative recurrence incidence of bilious vomiting were recorded and compared. Results: In neonatal group, patients who underwent diaphragmectomy showed shorter operational time, total enteral nutrition time and hospital stay, compared with diamond-shaped anastomosis patients. In younger infant group, patients who underwent diaphragmectomy had shorter operation time and lower weight in 2 months after surgery,but longer total enteral nutrition time and hospital stay, compared with diamond-shaped anastomosis patients. In elder infant group, compared with diamond-shap anastomosis group, patients in diaphragmectomy group showed longer functional recovery time, total enteral nutrition time and hospital stay, higher postoperative recurrence incidence of bilious vomiting (P＜0.05). Conclusion: To younger infants with perforate duodenal diaphragm, the diaphragmectomy was more suitable, while diamond-shaped anastomosis was better to elder ones.
收稿日期: 2013-03-19
作者简介: 路长贵（1984—），男，江苏建湖人，硕士，主治医师，主要从事消化道畸形的研究。
引用本文:
路长贵, 唐维兵, 耿其明, 徐小群, 将维维, 陈焕, 吕小逢. 十二指肠有孔隔膜状狭窄手术方法探讨[J]. 江苏大学学报:医学版, 2013, 23(5): 436-439.
LU Chang-gui, TANG Wei-bing, GEN Qi-ming, XU Xiao-qun, JIANG Wei-wei. Operation approach to children with congenital duodenal diaphragm. Journal of Jiangsu University(Medicine Edition), 2013, 23(5): 436-439.
[1] Mustafawi AR, Hassan ME. Congenital duodenal obstruction in children: a decade′s experience［J］. Eur J Pediatr Surg, 2008, 18(2): 93-97.［2］Grosfeld JL, Rescorla FJ. Duodenal atresia and stenosis: reassessment of treatment and outcome based on antenatal diagnosis, pathologic variance, and long-term follow-up ［J］. World J Surg, 1993, 17(3):301-309.［3］Nawaz A, Matta H, Jacobsz A, et al. Congenital duodenal diaphragm in eight children［J］. Ann Saudi Med, 2004, 24(3):193-197.［4］Lin HH, Lee HC, Yeung CY, et al. Congenital webs of the gastrointestinal tract: 20 years of experience from a pediatric care teaching hospital in taiwan［J］. Pediatr Neonatol, 2012, 53(1):12-17.［5］Monga R, Tyagi P, Garg S, et al. Endoscopic management of multiple duodenal diaphragms:case report［J］. Gastrointest Endosc, 2003, 58(1):158-160.［6］Vrsansky P. Our Modification of duodeno-jejuno-anastomosis;comment upon article duodenal atresia: a comparison of three modes of treatment［J］. Eur J Pediatr Surg, 1996, 6(6):381.［7］Upadhyay V, Sakalkale R, Parashar K, et al. Duodenal atresia: a comparison of three modes of treatment［J］. Eur J Pediatr Surg, 1996, 6(2):75-77.［8］Nawaz A, Matta H, Jacobsz A, et al. Congenital duodenal diaphragm in eight children［J］. Ann Saudi Med, 2004, 24(3):193-197.［9］Noda K, Nguyen B. Congenital duodenal diaphragm［J］. Dig Endosc, 2011, 23 (1):101-102.［10］Spigland N, Yazbeck S. Complications associated with surgical treatment of congenital intrinsic duodenal obstruction［J］. J Pediatr Surg, 1990, 25(11):1127-1130.［11］Steyaert H, Valla JS, Van Hoorde E. Diaphragmatic duodenal atresia: laparoscopic repair［J］. Eur J Pediatr Surg, 2003, 13(6):414-416.
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