胎粪性肠梗阻诊治经验

Diagnosis and treatment of meconium ileos PEI

目的总结我院对胎粪性肠梗阻的诊治经验。方法回顾我院7年间收治的13例胎粪性肠梗阻患儿临床资料，男6例，女7例，早产儿8例，低体重儿6例。10例简单型，3例复杂型。着重从症状、年龄、性别、出生体重等临床特征进行分析总结，重点讨论术前诊断，术中处置，一期手术后的处理经验。结果保守治疗1．例，经阑尾残端行胎粪疏通2例，一期行肠切除吻合1例，术后恢复良好，回肠造瘘术9例，其中5例行了关瘘，3例造瘘后放弃治疗，1例造瘘后失去联系，所有病例未见有纤维囊性病变症状。结论胎粪性肠梗阻好发于早产及低体重儿，胎粪性肠梗阻似乎并不是纤维囊性病变的伴发症状。不手术不灌肠的保守治疗需慎重，条件允许可行一期肠切除吻合或胎粪疏通，处置得当的双腔造瘘是较好的选择之一。

Objective To summarize our experience on the diagnosis and treatment of meconium ileus （MI）. Methods In the last 7 years, 13 patients included 6 males and 7 females were diagnosed with MI, and underwent treatment at this department. Among these patients, 8 patients were prema- ture infants, and 6 were low birth weight newborns. Ten were simple MI, and the other 3 were com- plicated MI. The symptom, age, gender, birth weight and other clinical data were analyzed retrospec- tively. Results One patient underwent conservative treatment. Two patients＂ meconium was removed by saline irrigation via the appendiceal stump. One patient underwent intestinal resection and anasto- mosis. All these 4 patients recovered without any complications after surgery. The other 9 patients underwent enterostomy, and 5 of them were performed secondary operation 3-12 months later to close the enterostomy. Three patients gave up further treatment and one lost follow-up. No symptom of cystic fibrosis was noted in all patients. Conclusions Meconium ileus is predominantly seen in prema- ture and low birth weight newborns. An individualized treatment plan should be made for each patient to improve the clinical outcome.