连续横向肠成形术在儿童肠衰竭治疗中的应用  

Serial transverse enteroplasty for the treatment of intestinal failure in children

作　　者：赵晓霞[1] 汪家莉 胡书奇 方舒 赖登明 秦琪[1] 钭金法[1] Zhao Xiaoxia;Wang Jiali;Hu Shuqi;Fang Shu;Lai Dengming;Qin Qi;Tou Jinfa(Department of Neonatal Surgery,Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Hangzhou310052,China)

机构地区：[1]浙江大学医学院附属儿童医院新生儿外科、国家儿童健康与疾病临床医学研究中心,杭州310052

出　　处：《中华普通外科杂志》2024年第11期839-843,共5页Chinese Journal of General Surgery

摘　　要：目的总结连续横向肠成形术(serial transverse enteroplasty,STEP)应用于儿童肠衰竭的单中心经验。方法回顾性分析2016年1月到2022年12月在本中心进行STEP手术的13例肠衰竭患儿的临床资料。结果女8例,男5例;早产儿10例,足月儿3例;胎龄为26+3~39+5周,出生体重860~3700 g。患儿手术的中位年龄为12个月,中位小肠长度为70(50~130)cm,术前肠管扩张直径约4.5~7.5 cm,手术间隔2.5~3.0 cm进行切割,连续横向小肠成形术使扩张的肠段长度平均增加75%(66%~100%),小肠总长度增加16.0%(12.5%~30.0%)。STEP术后13例患儿中,有12例(92.3%)脱离了肠外营养达到剩余肠管的肠适应,脱离肠外营养的中位时间为术后138(20~1011)d。2例发生肠管再扩张,4例出现消化道出血,经保守治疗后好转。结论STEP手术适用于患儿小肠长度较短且扩张明显的肠管,既缩小扩张肠管直径,又可延长肠管长度,增加喂养耐受性,可提高临床肠内营养疗效,缩短患儿达到肠适应的时间。ObjectiveTo summarize the single-center experience of serial transverse enteroplasty(STEP)in children with intestinal failure.MethodsThe clinical data of 13 children who underwent STEP surgery at our department from Jan 2016 to Dec 2022 was retrospectively analyzed.ResultsEight children were females,5 were males.There were 10 premature infants and 3 full-term infants.The gestational age was 26+3-39+5 weeks,and the birth weight was 860-3700 g.The median age of surgery was 12 months,the median length of small intestine was 70(50-130)cm,the diameter of preoperative intestinal dilation was about 4.5 to 7.5 cm,and the operation interval was 2.5 to 3.0 cm.Continuous transverse enteroenteroplasty resulted in an average increase of 75%(66%to 100%)in the length of the dilated intestinal segment.The total length of the small intestine increases by 16.0%(12.5%-30.0%).After the operation,12 of the 13 children(92.3%)were removed from parenteral nutrition to achieve intestinal adaptation of the remaining bowel,and the mean time of withdrawal from parenteral nutrition was 138(20-1011)days after the operation.Intestinal dilatation occurred in 2 patients,and gastrointestinal bleeding occurred in 4 patients,which healed after conservative treatment.ConclusionsSTEP operation is suitable for children with short intestinal length and obvious expansion of intestinal tube.STEP can not only reduce the diameter of the enlarged intestine,but also extend the length of the intestine,increase the feeding tolerance,improve the clinical effect of enteral nutrition,and shorten the time for children to achieve intestinal adaptation.

关 键 词：儿童 胃肠外营养 肠衰竭 连续横向肠成形术 

分 类 号：R726.5[医药卫生—儿科]