小儿结肠狭窄三例并文献复习  

Diagnosis and treatment of colonic stenosis in children:a report of 3 cases and literature review

作　　者：赵正[1] 王建峰[1] 席红卫[1] 石正峰[1] Zhao Zheng;Wang Jianfeng;Xi Hongwei;Shi Zhengfeng(Department of General Surgery,ShanXi Children's Hospital,Taiyuan 030013,China)

机构地区：[1]山西省儿童医院普通外科,太原030013

出　　处：《中华小儿外科杂志》2020年第3期238-242,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨小儿结肠狭窄可行且实用的诊治方法。方法回顾性分析2008年7月至2018年7月收治的3例乙状结肠狭窄患儿的临床资料。其中,男2例,女1例;年龄9个月至2岁1个月。通过Pubmed数据库、万方医学网及申请文献传递等方式收集并详细分析小儿结肠狭窄并手术治疗的文献资料。本次检索的关键词为结肠狭窄(Colonic stenosis及Colonic stricture)和小儿(Child)。文献的发表时间范围为1968年1月至2018年11月。结果本组中1例有新生儿坏死性小肠结肠炎(NEC)病史,合并回肠末端狭窄。另2例为先天性乙状结肠狭窄,其中1例合并凝血系列异常。3例均导致急性肠梗阻并手术,1例行狭窄结肠切除,端端吻合术;2例行一期狭窄段切除加近端肠造瘘,二期关瘘手术。3例术后均恢复良好,随访至今无并发症。将检索到的文献分为先天性结肠狭窄组及继发性结肠狭窄组。其中,先天性结肠狭窄组共检索到19篇文献22例,行一期狭窄结肠切除并吻合术9例(41%),二期狭窄结肠切除并近端肠造瘘分期手术4例(18%),余者不详。继发性结肠狭窄组检索到31篇文献共180例;以NEC继发结肠狭窄为主要原因,检索到16篇文献共158例。结论小儿结肠狭窄临床罕见,病因分为先天性及继发性,继发原因以NEC为主;临床表现取决于狭窄的严重程度;切除狭窄结肠为主要治疗方式,可行一期端端吻合或肠造瘘分期术,多处肠狭窄多采用分期手术。Objective To explore the feasibility,diagnosis and treatment of colonic stricture in children.Methods Three children of sigmoid stenosis were hospitalized from July 2008 to July 2018.Their clinical data were retrospectively analyzed.There were 2 boys and 1 girl with an age range of 9 to 25 months.The literatures of clinical characteristics and surgical treatments of pediatric colonic stenosis were retrieved from the databases of PubMed,Wanfang and application document delivery.The key words included colonic stenosis,colonic stricture and child.The literature cutoff period started from January 1968 to November 2018.Results One case with a previous history of neonatal necrotizing enterocolitis(NEC)had sigmoid stenosis and terminal ileum stenosis.Among another two cases of congenital sigmoid stenosis,one was associated with coagulation abnormalities.All 3 cases were operated for acute intestinal obstruction.One case underwent colonic stenosis resection with end-to-end anastomosis while the remainder were operated in stages.The first stage was stenotomy plus proximal enterostomy and the second stage closure of fistula.All children recovered well postoperatively and no complication occurred during follow-ups.The retrieved literatures were divided into congenital and acquired colonic stenosis groups.In congenital colonic stenosis group,19 articles were retrieved and 22 cases were reported.The operative stages were I(9/22,41%)and II(4/22,18%).The remainder was not described.A total of 31 literatures were retrieved in pediatric acquired colonic stenosis group(n=180)and NEC acquired colonic stenosis group(n=158).Conclusions Colonic stenosis is clinically rare and its etiology is due to congenital and acquired causes.The acquired cause is predominantly NEC.The clinical presentation depends upon the severity of stenosis.The selection of treatments is dependent upon age of onset,degree of stenosis,location and presence/absence of complications.Sigmoid stricture resection may be completed by one-stage end-to-end anastomosis o

关 键 词：结肠疾病 狭窄 儿童 

分 类 号：R726[医药卫生—儿科]