活瓣式小肠造瘘术在新生儿腹部外科疾病中的应用分析  

Application of valve enterostomy during neonatal surgery

作　　者：王金虎[1] 赵绪稳[1] 杜晓斌[1] 戴春娟[1] 胡博[1] 包国强[1] Wang Jinhu;Zhao Xuwen;Du Xiaobin;Dai Chunjuan;Hu Bo;Bao Guoqiang(Department of Neonatal Surgery,Municipal Children's Hosptial,Tianjin 300134,China)

机构地区：[1]天津市儿童医院新生儿外科

出　　处：《临床小儿外科杂志》2020年第1期36-39,共4页Journal of Clinical Pediatric Surgery

基　　金：天津市卫生局科技基金项目(编号:2013KY12)

摘　　要：目的探讨活瓣式小肠造瘘术在降低新生儿及婴儿小肠造瘘术后并发症中的临床应用价值。方法根据治疗方案的不同将入选的患儿分为活瓣式肠造瘘术组(13例)以及常规肠造瘘术组(10例),其中活瓣式肠造瘘术组采用袢式造瘘的方法,先将肠管浆肌层与腹膜及腹壁肌层缝合固定,在与该缝合层面约一个肠管直径距离处将肠管浆肌层与皮肤、皮下、腹壁肌肉一并缝合固定,使处于腹壁内的肠段形成类似回盲部的“瓣样”皱襞结构。对比活瓣式小肠造瘘术组与常规肠造瘘组术后水电失衡情况,皮肤糜烂、肠管脱出的发生率及排便情况。结果与常规造瘘术组相比,活瓣式造瘘术组患儿每日每百毫升进奶量对应的排便质量显著降低[(25.95±3.39)g vs.(22.23±2.49)g,P<0.05],每日每千克体质量对应的排便质量显著降低[(27.05±3.31)g vs.(23.23±2.64)g,P<0.05],每周体质量增长量显著提高[(136.42±20.23)g vs.(154.27±16.74)g,P<0.05];同时可以有效预防肠管脱出,并减轻瘘口周围皮肤糜烂程度。结论活瓣式小肠造瘘术可以减少肠造瘘口排便内容物中的水分含量,降低新生儿及婴儿小肠造瘘术后并发症的发生率,减轻护理负担,显著改善预后。Objective To explore the clinical value of flap-type small intestine fistula in reducing postoperative complications of neonatal/infantile small intestine fistula.Methods According to the different treatment options,23 selected children were divided into valve-type enterodenectomy group(n=13)and conventional enteric fistula group(n=10).In valve-type enterostomy group,muscle layers of intestinal tract,peritoneum and abdominal wall were sutured together with skin,subcutaneous layer and abdominal wall at a distance from suture level.The inner segment of intestine formed a flap-like crease structure similar to ileocecal portion.The changes of hydroelectric imbalance,skin erosion,intestinal tube prolapse and defecation were compared between two groups.Results Compared with conventional ostomy group,flap-like operation could reduce the daily quality of defecation per 100 ml of milk(P<0.05),lower the daily mass per kilogram of body weight and(P<0.05)and boost weekly body mass growth(P<0.05);at the same time,it effectively prevented intestinal tube prolapse and reduce the degree of skin erosion around stoma.Conclusion Valve-type small intestine fistula can reduce fecal water content in bowel fistula,lower the incidence of postoperative complications after operations for intestinal fistula,lessen the burden of care and significantly improve the prognosis in neonates and toddlers.

关 键 词：肠造口术 婴儿 新生 治疗结果 

分 类 号：R726[医药卫生—儿科] R574.5[医药卫生—临床医学]