摘要
目的 评价肠折叠术在肠闭锁手术中的应用效果.方法 回顾分析2005年4月至2009年4月南京医科大学附属南京儿童医院收治的68例肠闭锁患儿术前、术中和术后恢复过程的临床资料,比较手术方法、胎龄、出生体重、伴发疾病、手术年龄和时间、住院时间、全静脉营养持续时间、肠功能恢复时间（术后经口喂养时间、术后经口喂养达40ml/3 h的时间）、生长发育以及是否需再手术等方面的差异.结果 根据手术方法将患儿分为二组,38例在切除闭锁盲端肠吻合基础上加肠折叠术（折叠组）,30例行扩张段斜行切除肠成形术（对照组）;二组在胎龄、出生体重、伴发疾病、手术年龄上差异无统计学意义;折叠组手术时间（1.21±0.24）h、住院时间（12.2±2.5）d比对照组（1.77±0.31）h、（17.3±3.2）d显著减少（P＜0.05）;折叠组术后经口喂养时间、术后经口喂养达40ml/3 h的时间和全静脉营养持续时间分别是（8±2.3）d、（13.1±1.9）d、（8.3±1.8）d,均比对照组（12.9±1.7）d、（18.7±1.1）d、（13.6±2.5）d显著缩短（P＜0.05）;术后半年内折叠组有1例因粘连性肠梗阻需再次手术,对照组共有6例术后半年内再次手术,其中术后功能性肠梗阻3例、吻合口漏2例、粘连性肠梗阻1例,比折叠组显著增加.术后平均随访时间为2.7年（6个月至5年）,二组生长发育达到正常标准,差异无统计学意义.结论 肠闭锁手术时在肠吻合基础上加肠折叠术,方法简单,创伤小,并发症少,有助于保留肠管吸收面积和促进肠功能恢复,可以作为预防肠闭锁扩张肠管功能性梗阻的一种有效选择方法.
Objective To evaluate the efficacy of bowel plication as a part the surgical treatment of intestinal atresia （IA） in childrea Methods Between April 2005 and April 2009,68 neonates with IA underwent surgical treatment in this center. According to the surgical procedures the patients underwent, the 68 neonates were divided into bowel plication group and control group. The 38 children underwent bowel plication after atretic segments resection and primary anastomosis. The 30 children of the control group underwent tapering enteroplasty after atretic segments resection. Data including operation procedures,ages,birth weight,concomitant diseases,age at surgery, length of hospital stay, length of total parenteral nutrition （TPN）,postoperative intestinal function recovery （the time of the first oral feeding and the oral feeding volume reached 40 ml/kg/3h）,growth and development,complications and reoperations were retrospectively analyzed. Results No differences of ages, birth weight, age at operation, and concomitant diseases were found between the two groups. The time of operation and hospital stay of the bowel plication group were significantly shorter than those of the control group [（1.21±0.24）h,（12.2±2.5）d vs. （1. 77 ± 0. 31）h, （17. 3 ± 3. 2）d,P〈0. 010]. The time of the first oral feeding, the time when oral feeding volume reached 40 ml/kg/3h,and TPN length of the bowel plication group were also shorter than those of control group [（8 ± 2. 3）d, （13. 1 ± 1. 9）d, （8. 3 ± 1.8）d vs （12. 9 ±1. 7）d,（18. 7 ± 1. l）d,（13. 6 ± 2. 5）d,P〈0. 05]. In the bowel plication group, 1 （2. 6%） underwent reoperation for adhesive intestinal obstruction half a year after the initial surgery. However,in the control group,6 （20%） included 3 underwent reoperation for intestinal obstruction,2 for anastomotic leakage and 1 for adhesive intestinal obstruction. The patients were followed up for an average period of 2. 7 years （6 months-5 years）. All infants thrived. Conc
出处
《中华小儿外科杂志》
CSCD
北大核心
2011年第5期347-350,共4页
Chinese Journal of Pediatric Surgery
