Bishop—Koop肠吻合肠造口术在难治型先天性小肠闭锁中的应用  

Application of Bishop-Koop stoma in refractory congenital intestinal atresia

作　　者：张红[1] 钟微[3] 孙静[3] 何秋明[3] 王勇[3] 李乐[3] 余家康[3] 王哲[3] 叶志华[3] 唐凯琳 夏慧敏[3] 

机构地区：[1]广州医科大学外科学,广州510182 [2]广州医科大学卫生管理学院,广州510182 [3]广州医科大学附属妇女儿童医疗中心新生儿外科,510623

出　　处：《中华胃肠外科杂志》2016年第10期1154-1159,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：广东省科技计划项目（2014A020212022）

摘　　要：目的探讨评价Bishop—Koop肠吻合肠造口术治疗难治型先天性小肠闭锁的可行性和安全性。方法回顾性分析广州医科大学附属妇女儿童医疗中心2011年1月至2014年12月期间应用Bishop—Koop肠吻合肠造口术治疗的25例难治型先天性小肠闭锁患儿的临床病例资料。其中男13例（52％），女12例（48％），入院时年龄10h至20d，出生体质量为1600～3800（平均2920）g，手术日龄为1～58（平均7）d。患儿闭锁近端肠管和闭锁远端肠管直径之比均〉4，其中高位空肠闭锁11例（44％）；闭锁DIb型3例（12％），闭锁Ⅳ型7例（28％）；合并复杂型胎粪性腹膜炎14例（56％）；再次手术3例（12％）。结果全组均成功完成Bishop—Koop肠吻合肠造口术，中位手术时间3（1．2～4．5）h，中位术中出血量3．5（1～18）ml。术后并发症发生率为20％（5／25），其中胆汁淤积征3例，坏死性小肠结肠炎1例，肠梗阻1例。术后1例患儿因合并坏死性小肠结肠炎和败血症，治疗无效于术后6d死亡，病死率为4％（1／25）；1例患儿因经济原因放弃治疗。其余23例患儿术后首次肠内营养时间中位数为11d，平均11（5～20）d；术后肠外营养使用时间中位数为15d，平均21（5～68）d；中位术后住院时间为25（12～81）d。23例患儿已行二期造口关闭术，术后均无手术相关并发症。造口术后出院时3例（13．0％）患儿体质量Z评分正常，20例（87．O％）低于正常范围；随访至造口关闭入院时，19例（82．6％）体质量Z评分正常，4例（17．4％）低于正常范围。23例患儿中9例（39．1％）术前血清白蛋白水平正常，出院时3例（13．0％）正常，造口关闭入院时22例（95．7％）恢复正常。结论Bishop—Koop肠吻合肠造口术治疗难治型先天性小肠闭锁安全可行。对患儿营养状况改善明显。Objective To explore the feasibility and safety of Bishop-Koop stoma procedure in the treatment of neonates with refractory congenital intestinal atresia. Methods Clinical and follow-up data of 25 neonates with refractory congenital intestinal atresia undergoing Bishop-Koop stoma procedure in our center from January 2011 to December 2014 were retrospectively analyzed. Of 25 neonates, 13 （52%） were male, 12（48%） were female, the birth weight was 1600-3800 g （mean 2920 g）, the age of admission was 10 hours to 20 days, and the age of operation was 1-58 d （mean 7 d）. Diameter ratio of proximal atresia intestine to distal atresia intestine was all greater than 4. Eleven cases （44%） were high jejunal atresia, 3 cases（12%） type Ⅲ b, 7 cases（28%） type Ⅳ, 14 cases（56%） were identified as complex meconium peritonitis, and 3 cases （12%） received reoperation. Results All the cases completed their Bishop-Koop stoma operations successfully with median operative time of 3 （1.2-4.5） hours and median intra-operative blood loss of 3.5 （1-18） ml. The postoperative complication rate was 20%（5/25）, including 3 cases of cholestasis, 1 case of ileus, and 1 case of neonatal necrotizing enterocolitis with septicemia who died 6 days after operation resulting in the mortality of 4%. Besides, 1 case gave up treatment because of economic reason. For the rest 23 neonates, the median first feeding time was 11 days and mean time was 11 （5 to 20） days; the median time of postoperative total parenteral nutrition （TPN） was 15 days and mean time was 21 （5 to 68） days; the median hospital stay was 33 days and mean hospital stay was 25 （12 to 81 ） days, respectively. Two-stage stoma closure operations were performed in all the 23 cases afterwards and no postoperative associated complications were found. When discharge after Bishop-Koop stoma operations, Z score of body weight was normal in 3 cases（13.0%） and lower than normal in 20 cases（87.0%）, while in hospitalization for s

关 键 词：Bishop—Koop 肠吻合术 先天性小肠闭锁 治疗效果 

分 类 号：R726.5[医药卫生—儿科]