新生儿小肠造瘘术后肠衰竭相关性肝病的营养管理、关瘘手术时机和结局  

Nutritional management,timing of enterostomy closure and outcome of intestinal failureassociated liver disease after neonatal enterostomy

作　　者：邢国栋 黄柳明 刘钢[1] 张璟 谢华伟 申州 Xing Guodong;Huang Liuming;Liu Gang;Zhang Jing;Xie Huawei;Shen Zhou(Department of Basic Surgery,Bayi Children’s Hospital Affiliated to the Seventh Medical Center of PLA General Hospital,Beijing 100700,China)

机构地区：[1]解放军总医院第七医学中心八一儿童医院基础外科,北京100700

出　　处：《发育医学电子杂志》2021年第1期55-59,共5页Journal of Developmental Medicine (Electronic Version)

基　　金：军队创新工程重点项目(16JS001)。

摘　　要：目的探讨新生儿小肠造瘘术后肠衰竭相关性肝病营养管理和关瘘手术的相关问题,并评估结局。方法选取2016年1月至2018年12月解放军总医院第七医学中心附属八一儿童医院基础外科18例诊断为肠衰竭的高位肠造瘘合并肠衰竭相关性肝病新生儿的临床资料进行回顾性分析。所有患儿于小肠造瘘术后予以营养支持,并尝试逐步向肠内营养过渡。但均未成功,都存在不同程度的依赖静脉营养支持,并合并肠衰竭相关性肝病。按照欧洲儿科胃肠病学、肝病学和营养协会指南和本中心临床经验进行个体化营养管理,患儿肝功能损伤及胆汁淤积呈进行性加重趋势,无法进一步肠外营养,体重增加困难,被迫提前行关瘘术。结果关瘘术后,16例可过渡至完全肠内营养,脱离静脉营养,达到出院标准,随访至术后2~6个月,患儿胆红素、肝功能均恢复至正常,体重追赶理想。4例患儿出现并发症,1例因出现粘连性肠梗阻于保守治疗期间出现感染、弥散性血管内凝血(disseminated intravascular coagulation,DIC)而死亡;1例出现吻合口狭窄,多次加奶后出现腹胀等不全性肠梗阻表现,于肠造瘘还纳术后2个月再次行手术治疗,切除狭窄吻合口,重新行肠吻合术,术后1个月患儿恢复良好,目前肝功能、胆红素已降至正常。出院患儿中,1例患儿因回盲部及结肠大部分切除出现腹泻症状,需间断住院改善脱水症状。结论新生儿肠造瘘术后肠衰竭相关性肝病患儿,采取合理的营养支持策略和恰当的关瘘时机,可以改善患儿预后。Objective To explore the related problems of nutrition management and operation of neonates after enterostomy diagnosed as intestinal failure associated liver disease(IFALD),and evaluate the prognosis of these neonates.Methods To retrospectively analyze the clinical date of 18 neonates with IFALD in Department of Pediatric Surgery,Bayi Children's Hospital Affiliated to the Seventh Medical Center of PLA General Hospital from January 2016 to December 2018.Nutritional support was given to all patients after enterostomy and gradually changed into enteral nutrition.However,they had varying degrees of dependence on intravenous nutrition support and were combined with IFALD eventually.Though we carried out the individual nutrition management in accordance with the guidelines of the European Association of Pediatric Gastroenterology,Hepatology and Nutrition and the clinical experience from our study center,children with liver function injury and cholestasis showed a progressive aggravation trend,and difficulties in further parenteral nutrition and weight gain.Thus they were forced to perform enterostomy closure in advance.Results After the operation,16 patients were finally transited to complete enteral nutrition,totally separated from intravenous nutrition and reached the discharge criteria.After 2-6 months of follow-up,the bilirubin level and liver function of them was restored to normal with an ideal catch-up in weight.Complications occurred in 4 cases,one patient died of infection and disseminated intravascular coagulation(DIC)during conservative treatment for adhesive intestinal obstruction;one patient suffered from anastomotic stenosis,followed by incomplete intestinal obstruction characterized by abdominal distention after increasing the volume of milk feeding.The operation was carried out once again 2 months after the ostomy,removing the anastomotic stenosis and reperforming the enteroanastomosis.The patient recovered 1 month after the surgery.One month after discharge,his liver function and bilirubin level had t

关 键 词：肠造瘘术后 肠衰竭相关性肝病 营养支持 关瘘术 

分 类 号：R722.1[医药卫生—儿科]