摘要
目的探讨肠折叠术在新生儿高位空肠闭锁手术中的应用疗效。方法回顾性分析2013年1月至2016年12月复旦大学附属儿科医院收治的新生儿高位空肠闭锁(屈氏韧带下30 cm以内)43例的临床资料。根据术中有无近端肠管折叠将患儿分为近端肠管折叠组(折叠组,18例)和无折叠组(对照组,25例),比较两组患儿胎龄、出生体重、伴发疾病、手术年龄和时间、静脉营养持续时间、肠功能恢复时间(术后经口喂养时间、经口喂养达40 ml/3 h时间)、术后住院时间、生长发育、有无再手术及并发症等方面的差异。结果43例高位空肠闭锁患儿均行手术治疗。两组患儿在出生胎龄和体重、伴发疾病、手术年龄和时间上差异无统计学意义。折叠组全静脉营养持续时间、术后经口喂养时间和经口喂养达40 ml/3 h的时间分别为(9.2±2.7) d、(9.4±3.1) d和(14.6±2.3) d,均较对照组(14.3±2.4) d、(13.5±2.6) d和(17.6±2.8) d短,组间比较,差异均有统计学意义(P<0.05)。折叠组住院时间为(15.3±3.1) d,较对照组(18.5±3.6) d短,组间比较,差异亦有统计学意义(P<0.05)。折叠组术后一年内有2例因肠梗阻再次入院,1例保守治疗成功,另1例再手术探查发现系NEC后肠狭窄致肠梗阻。对照组术后一年内有5例再次手术,其中术后吻合口狭窄梗阻3例,粘连性肠梗阻2例。术后平均随访时间为2.8年(6个月至4年6个月),两组生长发育指标比较差异无统计学意义。结论新生儿高位空肠闭锁手术时在肠吻合成形基础上加行肠折叠术,创伤小,有助于促进肠功能恢复,并发症少,可以作为近端扩张肠管处理的一种有效方式。
Objective To evaluate the efficacy of bowel plication as a part of surgical treatment in neonatal high jejunal atresia.Methods Between January 2013 and December 2016,43 neonates with high jejunal atresia were operated.According to the specific surgical procedures,they were divided into bowel plication (n=18) and control (n=25) groups. The bowel plication group underwent proximal bowel plication after resecting atretic segments and primary anastomosis.The control group underwent enteroplasty after resecting atretic segments.The relevant data included gestational age,birth weight, concomitant diseases,age at surgery,operative duration,length of total parenteral nutrition (TPN),postoperative recovery of intestinal function (time of initial oral feeding and oral feeding volume reaching 40 ml/3 h),length of hospital stay, growth & development,complications and reoperations were retrospectively analyzed.Results No inter-group differences existed in gestational age, birth weight,concomitant diseases, age at surgery and operative duration. The time of initial oral feeding, time of oral feeding volume reaching 40 ml·kg-1·3 h-1 and TPN length of bowel plication group were shorter than those of control group [(9.4±3.1), (14.6±2.3), (9.2±2.7) vs. (13.5±2.6), (17.6±2.8), (14.3±2.4) days, P<0.05]. The length of hospital stay of bowel plication group were significantly shorter than those of control group [(15.3±3.1) vs. (18.5±3.6) days, P<0.05]. In bowel plication group, 1 (5.6%) underwent reoperation for intestinal stenosis after neonatal necrotizing enterocolitis at 1 year after initial operation. However, in control group, 3(12%) were re-operated for anastomotic stenosis and 2 for adhesive intestinal obstruction.The average follow-up period was 2.8 (0.5-4.5) years.All infants thrived and there were no inter-group differences in growth & development.Conclusions Additional bowel plication after atretic segment resection and primary anastomosis improves the clinical outcomes for neonates with high jejunal atresia.
作者
杨少波
王敏
沈淳
Yang Shaobo;Wang Min;Shen Chun(Department of Surgery, Affiliated Children’s Hospital, Fudan University, National Center for Children’s Health, Shanghai 201102, China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2018年第12期905-908,共4页
Chinese Journal of Pediatric Surgery
关键词
肠闭锁
肠梗阻
新生儿
Intestinal atresia
Intestinal obstruction
Neonate
