425例小儿肠造瘘分析

Clinical analysis on 425 cases of enterostomy in children

目的探讨小儿肠造瘘的临床治疗经验。方法回顾性分析近10年来行肠造瘘425例的临床资料。结果425例行肠造瘘患儿的原发疾病包括:肠穿孔119例,肠坏死36例,坏死性小肠结肠炎45例,先天性巨结肠61例,先天性无肛并直肠尿道瘘86例,先天性无肛并直肠阴道瘘78例。其中小肠造瘘159例,结肠造瘘266例;单口造瘘228例,双口造瘘197例。随访389例,均二期顺利关瘘。关瘘时间:小肠造瘘首次术后1～3(平均1.87)个月,结肠造瘘为术后3～12(平均7.95)个月。结论实施肠造瘘时应根据患儿的病情选择合适的时机、选择合适的肠造瘘部位。二期关瘘时间的选择也至关重要。

Objective To study the management of enterostomy in children. Methods The clinical data of 425 cases of enterostomy in children were analyzed retrospectively. Results The primary diseases of 425 cases underwent enterostomy included ： intestinal perforation （ 119 cases ） , intestinal necrosis （ 36 cases ） , necrotizing enterocolitis （ 45 cases ） , congenital megacolon （ 61 cases ） , congenital anal atresia with rectourethral fistula （86 cases ） , and congenital anal atresia with rectovaginal fistula （78 cases）. Among the 425 cases, 159 cases underwent small bowel enterostomy and 266 cases had colostomy; single-stoma enterostomy was done in 225 cases, and double-stoma enterostomy in 197 cases. Follow-up was acquired in 389 patients, and all the stomas were closed successfully. The closure time of small bowel enterostomy was 1 -3 month （ayerage 1.87 months） later, and of colostomy was 3 -12 month （averag 4.95 months ） later. Conclusions When an enterostomy is to be adopted in pediatric surgery, a suitable time and enterostomal location should be chosen according to the state of illness. The timing of enterostomy closure is also very important.