一种新型儿童肠造口封堵器在T型肠造口术后造口封堵中的应用及安全性初探  

A preliminary investigation on efficacy and safety of a novel pediatric conseal ostomy plug in children with Type T ostomy

作　　者：付翠霞[1] 陈劼[1] 陈琳[1] 沈淳[1] 何炜婧[1] 朱海涛[1] 马丽丽[1] Fu Cuixia;Chen Jie;Chen Lin;Shen Chun;He Weijing;Zhu Haitao;Ma Lili(Department of Pediatric Surgery,Children's Hospital of Fudan University,National Children's Medical Center,Shanghai 201102,China)

机构地区：[1]国家儿童医学中心复旦大学附属儿科医院外科,上海市201102

出　　处：《临床小儿外科杂志》2021年第10期974-979,共6页Journal of Clinical Pediatric Surgery

基　　金：复旦大学附属儿科医院多学科诊疗(MDT)拔尖项目(第二期)(编号:复旦儿科-2020);上海市科技创新行动计划医学创新研究专题项目(编号:21Y11907300)。

摘　　要：目的总结一种新型儿童肠造口封堵器应用于T型肠造口术后造口封堵的经验,并初步评价其临床疗效与安全性。方法以复旦大学附属儿科医院2019年10月至2020年10月收治的14例使用新型肠造口封堵器进行造口封堵试验的T型肠造口手术病例为研究对象;评估置入封堵器后肠造口有无漏液,造口肠管色泽和周围皮肤情况及封堵期间腹胀、呕吐、排便障碍等并发症发生情况。结果14例中包括坏死性小肠结肠炎伴或不伴肠穿孔7例,巨结肠类源病4例,早产儿动力性肠梗阻、脐膨出伴肠穿孔及胎粪性腹膜炎伴肠闭锁和肠扭转各1例。行Santulli造口与Bishop-Koop造口各7例,均为小肠造口。造口封堵时患者平均年龄为(9.3±5.8)个月,平均体重为(7.3±2.5)kg,封堵前造口平均排出量为每日(13.6±7.7)mL/kg。新型造口封堵器包含柱体塞与中心塞两部件,13例采用中心塞封堵,1例因合并肠造口脱垂而采用柱体塞联合中心塞进行封堵。14例均耐受封堵试验,平均封堵时间为(9.5±10.9)天,封堵后肠造口平均排出量为每日(1.5±3.9)mL/kg。封堵期间均未出现过敏反应,无肠管黏膜破损、造口周围皮肤糜烂及压力性损伤发生,无腹胀、呕吐等症状,肛门口均能自主排气排便。13例随后接受肠造口关闭术,术后无并发症,预后良好,1例目前仍住院接受肠造口封堵治疗中。结论该新型肠造口封堵器使用与护理简便,安全性佳,并具有良好的封堵效果,两部件及不同规格大小设计使其适合于不同T型肠造口封堵试验需求。同时可为T型肠造口关闭术后肠功能状态及患者耐受性的术前评估提供可行方案。Objective To review our institutional experience of applying a novel pediatric conseal ostomy plug among children with type T ostomy and explore preliminarily its clinical efficacy and safety.Methods Retrospective review was conducted for 14 patients with type T ostomy from October 2019 to October 2020.Patient demographics,ostomy output after plugging,perfusion of bowel wall and skin change around ostomy were assessed.And the complications of abdominal distention,emesis and abnormal bowel movement during plugging were recorded.Results Major causes for ostomy were necrotizing enterocolitis with or without bowel perforation(n=7)and neuronal intestinal dysplasia(n=4).And minor causes were ileus in preterm baby(n=1),omphalocele with bowel perforation(n=1)and meconium peritonitis(n=1).Both Santulli(n=7)and Bishop-Koop(n=7)intestinal ostomies were performed.The average age and weight during ostomy were(9.3±5.8)months and(7.3±2.5)kg respectively.The average ostomy output before plugging was(13.6±7.7)mL/kg/day.This novel conseal ostomy plug had two components of base and central plugs.Central plug was applied with base(n=13)and for ostomy prolapse(n=1).The average duration of plugging was(9.5±10.9)days.Ostomy output after plugging was(1.5±3.9)mL/kg/day.No allergic reaction,mucous injury,skin bruising or pressure injury occurred.All patients had normal spontaneous bowel movement without abdominal distension or emesis.Subsequent ostomy inversion was successful and uneventful postoperatively(n=13).One child continued treatment in hospital.Conclusion Using and nursing of this novel conseal ostomy plug are convenient,safety and efficient.The design of two components and serial size contribute to a broader application in most patients with type T ostomy.Also it provides a novel mode of predicting bowel function and tolerance in patients after ostomy closure.

关 键 词：肠造口术/方法 治疗结果 皮肤/损伤 病人安全 

分 类 号：R472.91[医药卫生—护理学] R574.2[医药卫生—临床医学]