自制可调节闭合环在T型造瘘术后发生短肠综合征中的应用  

Application value of adjustable closed loop in SBS with ostomy in continuity

作　　者：高琪 兰照平 谢卫科 王琪[1] 潘永康 卢朝祥 李中文 王磊[1] Gao Qi;Lan Zhaoping;Xie Weike;Wang Qi;Pan Yongkang;Lu Chaoxiang;Li Zhongwen;Wang Lei(Department of Neonatal Surgery,Children's Hospital Affiliated to Xi'an Jiaotong University,Xi'an,Shannxi 710003,China;Graduate School of Xi'an Medical College,Xi'an,Shannxi 710061,China)

机构地区：[1]西安交通大学附属儿童医院新生儿外科,710003 [2]西安医学院研究生院,710061

出　　处：《中国基层医药》2020年第17期2107-2111,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：陕西省西安市"科技"+行动计划医学研究项目(2019114613YX001SF042(6));陕西省自然科学基础研究计划一般项目(青年)(S2020JQ-931);西安交通大学附属儿童医院院级课题(2018E01,2018C03,2018C01)。

摘　　要：目的探讨自制的可调节闭合环在辅助治疗小儿肠切除术后发生短肠综合征(Short Bowel Syndrome,SBS)中的有效性和安全性,为SBS患者如何改善水电解质平衡提供参考。方法分析2017年1-12月在西安交通大学附属儿童医院新生儿外科行小肠T型造瘘术的2例患儿临床资料,手术时年龄分别为1个月、3个月,女婴,术后保留的近端肠管长度为65 cm、60 cm;2例患儿术后经口喂养后均出现了SBS表现,每日经造瘘口排出大量稀水便;将自制的闭合环用来控制大便的排出起到水电解质重吸收的作用。比较安装闭合环前后外置肠管的血运情况、体质量、体质量指数(BMI)、造瘘口以及肛门排便、腹部情况、营养状态变化、护理方便性、肠道感染易感性等。结果2例患儿对闭合环适应性良好,与腹壁及造瘘肠管的兼容性良好;无肠管坏死;经造瘘口排出稀水便量减少、营养状态改善、体质量增加,差异均有统计学意义(均P<0.05);水电解质吸收增加,造瘘护理管理更加方便,2例患儿治疗期间均未出现肠道感染。结论采用自制闭合环辅助治疗T型造瘘的SBS患儿有助于肠道管理,值得进一步研究。Objective To evaluate the effect and safety of adjustable closed loop(ACL)in the treatment of short bowel syndrome(SBS).Methods From January 2017 to December 2017,the clinical data of 2 cases with ostomy in continuity after surgery in Children's Hospital Affiliated to Xi'an Jiaotong University were analyzed.The age was 1 and 3 months,both were females,and preservation of intestinal tube length were 65 cm and 60 cm respectively.They were all diagnosed SBS with a lot of stool like water.Self-made ACL was installed to maintain SBS.The blood circulation of stoma,weight,BMI,defecating,abdomen,nutrition status changes,nursing convenience,intestinal infection susceptibility were observed.Results There was no necrosis in stoma,and the overall condition was improved,and no significant increase in abdominal distension.ACL used in babies with ostomy in continuity could improve the anus stool,weight,nursing convenience.Conclusion ACL installed in baby with SBS could contribute to intestinal management,and is easy to install.

关 键 词：短肠综合征 肠造口术 伤口闭合技术 腹泻 体重变化 营养不良 水电解质失调 婴儿 

分 类 号：R726.5[医药卫生—儿科]