新生儿35例肠造瘘术后二期手术方式的选择  

Selection of second stage operation after enterostomy in 35 neonates

作　　者：鲍俊涛[1] 秦璐莹[2] 杨凯骅 孟庆磊[1] 张书峰[1] Bao Juntao;Qin Luying;Yang Kaihua;Meng Qinglei;Zhang Shufeng(Department of Pediatric Surgery,Henan Provincial People′s Hospital,Zhengzhou 450003,China;School of Nursing and Healthy,Zhengzhou University,Zhengzhou 450001,China)

机构地区：[1]河南省人民医院小儿外科,郑州450003 [2]郑州大学护理与健康学院,450001

出　　处：《中华实用儿科临床杂志》2021年第14期1082-1085,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨新生儿肠造瘘术后二期手术方式的选择策略。方法回顾性分析2014年5月至2019年12月河南省人民医院小儿外科收治的35例新生儿期曾接受肠造瘘手术患儿,二期行根治手术。术前详细询问病史,均行钡灌肠造影、24 h延迟拍片、肛门直肠测压等检查,术中根据个体病情行多点肠管活检及快速冷冻病理检查,结合术中探查情况决定具体手术方式。术后观察有无吻合口瘘、肠梗阻、腹腔感染等并发症及肠功能恢复、排便情况、营养状况等中远期效果。结果9例诊断为新生儿坏死性小肠结肠炎(NEC),行关瘘术;16例诊断为NEC合并肠狭窄,行狭窄肠管切除吻合术+关瘘术;10例诊断为先天性巨结肠,其中5例为全结肠型巨结肠,行Soave巨结肠根治术,3例为长段型巨结肠,行结肠次全切除Deloyers法翻转升结肠肛管吻合术+再次造瘘,2例为常见型巨结肠,行经肛门巨结肠治疗术+关瘘术。术后1例吻合口瘘并感染性休克,1例切口裂开,3例黏连性肠梗阻,1例左侧肺实变。随访3~36个月,恢复尚可。结论对于新生儿期行肠造瘘手术患儿,二期手术前应详细追问病史,钡灌肠造影、24 h延迟拍片、术中多点肠管活检等检查结合术中探查情况,有助于选择合适个体化手术方案,减少手术并发症,提高患儿远期生活质量。Objective To explore the strategy of selecting the second stage operation after neonatal enterostomy.Methods Clinical data of 35 cases admitted to the Department of Pediatric Surgery of Henan Provincial People′s Hospital for enterostomy in neonatal period and radical operation in the second stage from May 2014 to December 2019 were subject to retrospective analysis.They were inquired about the medical history in detail before the operation,and received barium enema and colonoscopy,24-hour delayed radiography,anorectal manometry and other examinations.During the operation,a multi-point intestinal biopsy and rapid frozen pathological examination were performed accor-ding to the individual′s condition,and the specific surgical method was determined in combination with intraoperative exploration.Postoperative observations were conducted for such complications as anastomotic leakage,intestinal obstruction,and abdominal infection,as well as such medium and long-term outcomes as intestinal function recovery,defecation,and nutritional status.Results Nine cases were diagnosed with neonatal necrotizing enterocolitis(NEC)and received ostomy closure.Sixteen cases were diagnosed with NEC concomitant with intestinal stenosis and received the narrow bowel enterectomy and anastomosis combined with ostomy closure;10 cases were diagnosed with Hirschsprung′s disease,including 5 cases of total colonic aganglionosis treated with Soave radical operation,3 cases of long-segment Hirschsprung′s disease treated with subtotal colectomy,inverted ascending coloanal anastomosis with Deloyers method and second enterostomy,and 2 cases of normal-segment Hirschsprung′s disease treated with pull-through operation combined with ostomy closure.After the operation,1 case had anastomotic leakage and septic shock,1 case had incision dehiscence,3 cases had adhesive intestinal obstruction and 1 case occurred left lung consolidation.During a follow-up period of 3-36 months,their recovery condition was acceptable.Conclusions For those neonates re

关 键 词：婴儿 新生 肠造瘘术 先天性巨结肠 小肠结肠炎 

分 类 号：R722.1[医药卫生—儿科]