先天性巨结肠非计划二次手术的原因分析

Causes analysis of unplanned secondary surgery of congenital megacolon

目的探讨先天性巨结肠术后非计划二次手术的原因，提高医疗技术水平，降低非计划二次手术率。方法选择郑州大学第三附属医院小儿外科2010年1月至2013年1月期间行巨结肠治疗术的病例资料526例，其中13例术后因各种原因非计划二次手术，对其进行回顾性分析，探讨先天性巨结肠非计划二次手术的原因。结果非计划二次手术率为2．5％，非计划二次手术原因包括粘连性梗阻（2例）、黏膜脱垂（2例）、小肠结肠炎（2例）、便秘复发（2列）、肠管回缩（1例），肠瘘（1例），出血（1例）、内疝形成（1例），切口裂开（1例）。结论先天性巨结肠非计划二次手术的原因既有其本身并发症的因素，亦有医源性因素，充分的术前准备、全面的术前讨论、术中仔细探查、严格按照规范谨慎操作，提高技术水平，是降低非计划二次手术率的美键．

Objective To investigate the causes of congenital megacolon unplanned secondary surgery, improve the level of diagnosis and treatment and reduce the rate of unplanned secondary surgery. Methods From Jan. 2010 to Jan. 2013, 526 eases of congenital megacolon in department of pediatric surgery, the third affiliated hospital of Zhengzhou university were chose. Among them, 13 patients had unplanned secondary surgery due to various reasons. Through respective analysis of the 13 cases, the causes of congenital megacolon unplanned secondary surgery were investigated. Results The rate of un- planned secondary surgery was 2. 5 %. The causes of congenital megacolon unplanned secondary surgery were as follows ： adhesive intestinal obstruction （2 cases）, intestinal mucosa prolapse （2 cases）, enterocolitis （ 2 cases ）, recurrent constipation （ 2 cases ）, insufflate retraction （ 1 case ）, intestinal fistula （1 case）, postoperative bleeding （1 case）, internal hernia formation （1 case）, incision dehiscence （ 1 case）. Conclusions The causes of congenital megacolon unplanned secondary surgery were its own complications and iatrogenic factors; Sufficient preoperative preparation, comprehensive preoperative discussion, intraoperative careful examination, carefully operation in strict accordance with the regulation, improve the level of technology, is the key to reduce unplanned secondary surgery.