高位小肠造瘘术后林格液肠内灌注的作用比较

The effect of postoperative enema of Ringer＇s solution in patients suffering proximal jejunal stoma

目的分析造瘘远端肠道内灌注林格液对高位小肠造瘘患儿术后恢复的作用。方法2005年1月至2007年8月收治小肠造瘘距Treize韧带距离≤60cm的13例患儿，分二组：A组7例，无造瘘远端肠道内灌注；B组6例，造瘘远端或肛门内给予林格液灌注治疗。13例患儿在造瘘术后的28-35d间均接受小肠造瘘关闭术。比较二组患儿术后TPN使用时间、达到完全肠道营养脱离补液所需时间、2次手术之间体重增加差异及预后。结果二组患儿术后TPN平均使用时间分别为（25．4±2．5）d和（18．9±7．2）d，差异无统计学意义；二组患儿达到完全肠道营养脱离补液所需平均时间分别为（31．6±5．3）d和（22．4±4．5）d（P〈0．05）；A组患儿二次手术之间平均体重下降0．116kg，B组患儿平均体重增加0．287kg（P〈0．05）；A组3例存活，4例死亡。B组5例存活，1例死亡。结论小肠高位造瘘患儿，术后肠外营养和肠道喂养同时，辅助性给予林格液经造瘘口远端或经肛门肠道内灌注，可有效缩短患儿术后脱离补液所需时间，逐步达到全肠道营养，有效增加患儿术后体重，改善预后。

Objective To analyze the effect of postoperative enema of Ringer＇s solution in distal end of stoma in the recovery of patients suffering proximal jejunal stoma. Methods From 2005 January to 2007 August, clinical data of 13 patients suffering proximal jejunal stomas with the distance from Treitz ligament less than 60cm in this hospital were retrospectively analyzed. All patients were divided into two groups： patients in Group A （n = 7） got no enema of Ringer＇s solution in distal end of stoma post operation while patients in Group B （n = 6） accepted enema of Ringer＇s solution. All patients underwent the procedures of stoma closure 28 to 35 days after proximal jejunal stoma. Period of total TPN, period of replacement of TPN by TEN, weight growth of patients between two operations, and the patients prognosis were compared between two groups. Results Average TPN period in two groups was （25.4 ± 2. 5）d and （18.9± 7. 2）d respectively,with no significant difference. Total enteral nutrition period in two groups was （31.6 ±5.3）d and （22. 4 ± 4. 5）d respectively（P〈0. 05）. Bodyweight of patients in group A decreased by 0. 116 kg versus that of patients in Group B increased by 0. 287 kg（P〈0. 05）. In group A,3 patients survived and 4 died; while in Group B,5 patients survived and 1 died. Conclusions Patients suffering proximal jejunal stomas who accepted assistant postoperative Ringer＇s solution enema have better prognosis than those who only accepted TPN and TEN. Respectively,enema of Ringer＇s solution decreases period of TPN and period of replacement of TPN by TEN. Meanwhile, it can significantly increase postoperative weight growth of patients.