超声监测下保守治疗婴儿先天性巨结肠根治术后吻合口漏的初步探索  

Conservative managements of anastomotic leak under ultrasonic monitoring for Hirschsprung’s disease in infants

作　　者：程天然 马亚 李颀[1] Cheng Tianran;Ma Ya;Li Qi(Department of General Surgery,Capital Institute of Pediatrics,Beijing 100020,China;Department of Ultrasonography,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所普通外科,北京100020 [2]首都儿科研究所超声科,北京100020

出　　处：《临床小儿外科杂志》2024年第9期825-829,共5页Journal of Clinical Pediatric Surgery

基　　金：北京市属医院科研培育项目(PX2020054)。

摘　　要：目的总结分析超声监测下保守治疗1岁以内婴儿先天性巨结肠根治术后吻合口漏伴局部脓肿的相关经验。方法回顾性分析2020年1月至2021年12月在首都儿科研究所普通外科行巨结肠根治术,并采用保守方法治疗的巨结肠根治术后吻合口漏伴局部脓肿患儿临床资料。保守治疗方法包括超声监测下采用局部麻醉下肛门扩张、脓肿外口置管引流、全身和局部抗感染以及留置肛管。收集患儿基本情况、发生吻合口漏的时间和部位以及治疗结果等,并评估患儿预后。结果共4例患儿纳入研究,男1例、女3例,手术年龄3~11个月,常见型2例、长段型1例、全结肠型1例。分别于术后7、15、21、50 d发现吻合口漏。吻合口漏外口均位于吻合口后壁6点处,均存在向上延伸至骶前的脓肿。经保守治疗后3例愈合,愈合时间为保守治疗后34、48、72 d;1例转肠造瘘术治愈。患儿肛门功能评估均可,无一例严重吻合口狭窄及窦道形成。结论1岁以内婴儿先天性巨结肠根治术后吻合口漏伴局部脓肿可以尝试超声监测下保守治疗,其中局部抗感染和保持引流通畅是保守治疗的关键,如保守治疗无效应及时手术干预。Objective To summarize and share our institutional experience in the conservative managements of anastomotic leak in infants under ultrasonic monitoring for Hirschsprung’s disease(HD)over the last two years.Methods From January 2020 to December 2021,a HD child underwent pull-through and conservative treatment was offered for anastomotic leak.Under ultrasound monitoring,anal dilatation,catheter drainage,systemic and local anti-infection and placing anal tube under local anesthesia and sedation were performed.The outcomes were summarized.Results There were 3 girls and 1 boy.The causes were recto-sigmoid segment HD(n=2),long segment HD(n=1)and total colonic aganglionosis(n=1).Operative age was(3-11)month.Anastomosis leak occurred at Day 7/15/21/50 post-operation.All external openings were located at 6 o’clock point with presacral abscess.Three cases healed at Day 34/48/72 and 1 child underwent enterostomy.Function was satisfactory without stricture or sinus tract formation.Conclusions HD with postoperative anastomotic leak and local abscess formation may be managed conservatively under ultrasonic monitoring.Non-responsive cases should be operated as soon as possible.

关 键 词：HIRSCHSPRUNG病 手术后并发症 吻合口漏 保守治疗 治疗结果 婴儿 

分 类 号：R47[医药卫生—护理学]