Analysis Of Clinical Aspects And Prognostic Factors Of Congenital Intestinal Atresia

Objective: Congenital intestinal atresia is one of the most commondigestive tract malformation in the neonatal period. Patients often withdifferent kinds of complications and clinical manifestations are very varabile.Early diagnosis and early treatment are very important in reducingcomplications. We collected the data of a group of patients with intestinalatresia. Based on the whole aspects of clinical data including the prenatalultrasonography, the clinical features of the ccongenital intestinal atresiaregarding the pathological type, location of the atresia, imaging characteristicsand the factors that would affect the prognosis and surgical methods wereanalyzed. In order to better understand the intestinal atresia and improving thecure rate and prognosis of the disease.Materials and methods： A retrospective study was performed onpatients who were admitted in the Children’s Hospital of Soochow Universitybetween January2007and June2012. The prenatal information clinical dataand follow up results were collected and analyzed for evaluating the clinicalfeatures regarding the pathological type, location of the atresia, imagingcharacteristics and the factors that would affect the prognosis and surgicalmethods with the software of SPSS17.0for Windows.Rusults: A total of74patients(41males,33females) with congenitalintestinal atresia, in which6patients ultimately gave up to treatment due tosevere postoperative complications and3died, were admitted in the hospital in six years. According to the final analysis, the site of the atresia mainlylocated in the small intestinal, accounting for93.24(69cases) of the totalcases. In which the duodenal atresia had a percentage of17.57%(13cases),jejunal28.38(21cases) and ileum47.30%(35cases). On the contrary, colonicatresia only occurred in5cases (6.76%). In the meantime, the pathologicalclassification falls into four types. Type I makes up a percentage of49.28(34cases) of all congenital intestine atresia, type II10.14(7cases), type IIIa27.5%(19cases), type IIIb5.80%(4cases) and type IV7.25%(5cases). Forthe result of prenatal ultrasonography, thirty one case(41.89%) revealedabnormal findings, such as dilated intestinal canal or air-fluid levels inintestine, sometimes accompanied by polyhydramnios in pregnancy. On thewhole, the positive rates of prenatal ultrsonography were as high as41.89%.Meanwhile the positive rates were different from the location of the atresia,with a rate of76%in duodenum (10in13cases),66%in jejunum (14in21cases),20%in ileum(7in35cases), and not a single patient with colonicatresia were detected by ultrosonography (0in5cases). Prenatal diagnosisgroup were significantly shorter than the postnatal diagnosis group, admittedearlier children gain support treatment and early diagnosis, early operationand treatment. The long term prognosis of the intestine atresia were mostlyaffected by the elements of the atresia locations, atresia type, gestational ageand the post-operative complications such as ileus.74cases of intestinalatresia, intestinal membrane resection in20cases, duodenal side to sidediamond anastomosis in2cases, duodenal jejunal anastomosis in2cases,intestinal resection and end to end or end to oblique anastomosis in37cases,intestinal fistula in13cases. The prognosis of type III, IV intestinal atresiawere better than that of type I, II, and high intestinal atresia had poor prognosis. Premature birth and postoperative ileus were important factorsaffecting the prognosis of intestinal atresia.Conclusion:1. Prenatal ultrasonography is a useful method forindicating the presence of the intestine atresia, especially the atresias locatedin the proximal segment of intestine. With a definitely diagnosis in the time ofpregnancy and surgical intervention immediately after birth, thepost-operation complications could be reduced.2. According to theoccurrence of the intestinal atresia location and pathologic types to choosereasonable operation method is the key factor improving cure rate andreducing the complications of the intestinal atresia.3. The location and typesof the intestinal atresia have a certain relationship with patients mortality.Preterm birth and postoperative intestinal obstruction are the independentfactor influencing the prognosis of patients with the intestinal atresia.