| Objective: Fetal bowel dilation can be detected in early-stage antenatally thanks to ultrasound and magnetic resonance imaging examination,while the correlation between fetal bowel dilation and gastrointestinal malformation remains deeply research to investigate.This article aims to analyze the clinical data and follow-up results of cases with fetal bowel dilation,to evaluate the risk of gastrointestinal malformation of neonates.Furthermore,this article retrospectively reviewed the treatment of congenital intestinal atresia,discussed the risk factors of prognosis.Methods: A retrospective analysis of cases with fetal bowel dilation and patients with congenital intestinal atresia admitted in our department of pediatric surgery from January 2014 to December 2019 was performed.The basic information of patients,clinical data and outcome of the treatment were collected.The outpatients were followed up at clinics or by telephone.Cases of fetal bowel dilation were divided into two groups by upper and lower digestive tract dilation to discover the correlations with gastrointestinal malformation.Patients with intestinal atresia were divided into duodenal atresia and jejunoileal atresia group.The effect of basic condition,development of the intestine,surgical procedure and other factors on the prognosis of intestinal atresia patients were discussed.Results: 113 cases of fetal bowel dilation were included in the first part.Among these,41 cases were diagnosed with upper digestive tract dilation(double-bubble sign)and72 were diagnosed with lower digestive tract dilation.40 cases were confirmed with annular pancreas,duodenal atresia or atresia in the initial part of jejunum in doublebubble sign group,the incidence of gastrointestinal malformation was 97.6%(40/41).In the group of lower digestive tract dilation,46 cases were confirmed with intestinal atresia,intestinal stenosis,mesenteric cyst and other gastrointestinal malformations by physical examination,gastrointestinal radiography or surgical exploration,the incidence of gastrointestinal malformation was 63.9%(46/72).The diameter of the dilated intestine ranged from 11-57mm(Mid=19mm),and the diameter of the dilated intestine/gestational week ratio had clinical predictive value for digestive tract malformation(AUC=0.906,p<0.001).The ratio of more than 0.4931 suggested the possibility of gastrointestinal malformation(the sensitivity was 0.831 and the specificity was 0.903).In the second part,134 patients with intestinal atresia were included(31 cases with duodenal atresia,100 cases with ileal atresia and 3 cases with colon atresia).The overall survival rate was 94.8%.The survival rate of the duodenal atresia group was 100%,and the length of hospitalization for premature infants was longer than term infants(36.0±17.0 vs.25.8±21.4,p=0.033).The survival rate of the jejunoileal atresia group was 93%,gestational age,birth weight and residual bowel length after surgery of surviving patients were superior to the dead(p=0.002,p=0.001,p=0.001).The duration of parenteral nutrition use and length of stay of patients with higher intestinal atresia were longer than those in patients with lower intestinal atresia(p=0.039,p=0.043).Placement of jejunal nutrition tube is beneficial for early enteral feeding(p=0.006).The birth weight and residual bowel length after surgery of patients in the enterostomy group were smaller than those in the anastomosis group(p=0.018,p=0.024).Conclusion: Fetal double-bubble sign is closely related to duodenal obstruction.When the ratio of the diameter of the dilated intestine/gestational age is more than 0.4931,gastrointestinal malformation is suggested.Premature birth,low birth weight and poor bowel development are the risk factors for death in intestinal atresia patients.The recovery of intestinal function in patients with higher intestinal atresia is slow,early enteral feeding can be achieved by placing a jejunal nutrient tube.Intestinal anastomosis can be the first choice for patients with jejunoileal atresia. |
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