应用人工补片和腹腔引流对胸腹联体婴儿分离术后粘连性肠梗阻的影响  

Application of Artificial Patching and Abdominal Cavity Drainage:Influence of Adhesive Ileus over Thoracoventropagus after Commissurotomy

作　　者：宋步需[1] 田延锋[1] 李芳[1] 裴永彬[1] 张峰[1] 刘擘[1] 张学明[1] 赵增仁[1] 

机构地区：[1]河北医科大学附属第一医院普通外科,石家庄050031

出　　处：《华北国防医药》2008年第3期33-35,F0003,共4页Medical Journal of Beijing Military Region

摘　　要：目的:探讨胸腹联体婴儿分离术后粘连性肠梗阻的预防及处理措施。方法:回顾性分析我院1例胸腹联体婴儿进行分离术的临床资料。结果:联体婴儿A婴和B婴分离成功,分离后腹壁巨大缺损应用Preclude心包膜加聚丙烯网片修复成功。术后A婴恢复较顺利,无腹腔并发症发生,至今仍存活。B婴于术后第14d出现肠梗阻,经保守治疗无效,于第25d急行剖腹探查术。术中见:Preclude心包膜与肠管无粘连,冗长的引流管被肠管包绕粘连,通道有3处肠管成角粘连,形成2处洞孔,并有肠管疝入绞窄。行肠粘连松解、肠切除肠吻合、回肠造瘘术。术后因并发严重肺部感染抢救无效,于第53d死亡,共存活78d。尸体解剖:Preclude心包膜与肠管无粘连,第2次手术粘连松解处又见轻度肠粘连,原腹腔引流管及回肠造瘘管处有肠粘连。结论:选择防粘连的人工补片修复腹壁缺损及正确放置和管理腹腔引流管,有助于防止胸腹联体婴儿分离术后粘连性肠梗阻的发生;严密观察、准确把握中转手术的时机,有利于改善分离术后粘连性肠梗阻的预后。Objective：To investigate the prevention and treatment of adhesive ileus after liver separation surgery on the thoracoventropagus. Methods：The clinical data of the surgical separation on the thoracoventropagus in The First Hospital of Hebei Medical University was retrospectively studied. Results ：The thoracoventropagus, Infant A and B,were successfully separated. After the separation,huge defect of abdominal walls was repaired successfully by Preclude pericardial membrane and polypropylene mesh. After the operation, Infant A recovered smoothly and has survived till now without celiac complication. Intestinal obstruction was found in Infant B on the 14th day after the surgery and it was inefficacious by way of conservative treatment. On the 25th day, emergency laparotomic exploration was done to Infant B. The surgery showed that intestine had no adhesion, redundant drainage tube was surrounded and adhered by intestine. There were three intestine angulated adhesions in the passage, two holes and intestine strangulated internal hernia were formed. Intestinal adhesion lysis, resection and anastomosis and ileostomy were done to Infant B. Severe ＂pulmonary infection＂ took place after the operation. On the 53rd day,Infant B died after surviving for 78 days. Autopsy： Preclude and intestine had no adhesion, mild intestinal adhesion was found again at the place of lysis which was done in the second operation, and intestinal adhesion was found in the former drainage tube and ileostomy tube. Conclusion：Afier surgical separation, the anti-adhesion artificial patch to repair abdominal wall defect should be done and abdomen drainage tube be correctly set and redound to prevent adhesive ileus of thoracoventropagus. The appropriate therapeutic method and surgery opportunity are of great importance in improving prognosis of adhesive ileus after surgical separation.

关 键 词：联体婴儿 肠粘连 肠梗阻 外科手术 

分 类 号：R726.229[医药卫生—儿科]