先天性十二指肠闭锁的诊断、治疗及对患者进一步发展的影响

Sosnowska Patrycja, Mańkowski Przemysław
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摘要

背景:先天性十二指肠闭锁(CDA)是一种常见的消化道异常,发生在妊娠早期。它通常与21三体和其他先天性缺陷共存。手术是唯一的治疗方法。本研究旨在探讨CDA与早期诊断、妊娠进程、并发先天性缺陷及儿童进一步发育的关系。方法:采用病史和自行设计的调查问卷,包括围产期访谈、先天性缺陷、出生后症状、诊断时间和方法、治疗结果等22个问题。结果:调查对象为2004年至2019年在我院就诊的31例CDA患者。根据收集到的资料,73.7%的患者产前确诊,平均确诊时间为妊娠28周。此外,37%的患者是早产儿,几乎一半的患者体重很低或很低。超过2/3的儿童存在先天畸形。在出生后的症状中,最常见的是腹胀和缺胎。大多数患儿在出生后24小时内进行手术。结论:产前诊断CDA可使原发性手术时间提前。产前诊断的新生儿术后症状较少,再手术较少,口服喂养耐受时间较短。其他先天性缺陷的共存增加了患者的死亡率。早产和体重过低是影响术后病程的重要因素。为了避免长期的并发症,提供随访是至关重要的。
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Congenital Duodenal Atresia Diagnosis, Treatment, and Influence on Further Development of Patients
Background: Congenital duodenal atresia (CDA) is a common and surgically treated digestive tract anomaly that develops in the early stage of pregnancy. It often coexists with trisomy 21 and other inborn defects. Surgery is the only way of treatment. This study aimed to investigate the relationship of CDA with early diagnosis, course of pregnancy, coexisting congenital defects, and further development of children. Methods: The data were collected using the medical history and a self-designed survey which consisted of 22 questions about the perinatal interview, coexisting inborn defects, after birth symptoms, time and methods of diagnosis, as well as the treatment outcome. Results: The surveys were sent to 31 patients who were diagnosed and treated because of CDA in our clinic between 2004 and 2019. According to the collected data, 73.7% of the patients were diagnosed prenatally with the mean time of diagnosis at 28th weeks of gestation. Moreover, 37% of the patients were preborn, and almost half of the patients had low and very low body weight. More than 2/3 of children presented coexisting inborn abnormalities. Among after birth symptoms, the most common ones were abdominal distention and lack of meconium. The majority of children were operated within 24 hours after birth. Conclusions: Prenatal diagnosis of CDA results in an earlier time of primary operation. Newborns diagnosed antenatally present fewer symptoms after the operation, fewer reoperations, and a shorter time of oral feeding toleration. The coexistence of other congenital defects increases patients’ mortality. The important factors that deteriorate the postoperative course are prematurity and low body weight. In order to avoid long-term complications, it is of utmost importance to provide follow-up.
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