先天性结肠闭锁18例诊治分析

Analysis of diagnosis and treatment of 18 cases with congenital colon atresia

目的：探讨结肠闭锁的病因、分类、临床表现、外科治疗及预后。方法收集本院2004年10月至2013年10月收治的18例结肠闭锁患儿临床资料，总结我们在诊疗方面的经验。结果18例患儿中，外院造瘘1例，本院急诊手术17例，均在入院后8～20 h内手术。闭锁部位发生在横结肠8例，升结肠3例，降结肠2例，结肠肝曲2例，结肠脾曲2例，乙状结肠1例。Ⅲ型14例，Ⅰ型2例，Ⅱ型2例。14例行一期肠吻合术，3例行乙状结肠造瘘，1例术中放弃治疗。全组有2例死亡。结论当闭锁发生在近端结肠时应选择回结肠吻合；当闭锁盲端在脾区以远，可以保留回盲部及部分近端结肠行结结肠吻合；如果闭锁盲端超过乙状结肠或患儿一般情况较差时，应先行肠造瘘。

Objetive To explore the etiology,classification,clinical manifestation,surgical treatment and prognosis of colonic atresia. Methods The medical data of patients between December 2004 to December 2013 with colonic atresia were reviewed,and experience on treatment was summarized. Results All the 18 patients underwent operation 8～20 hours after admission.Among which,17 received emergency operation in our hospital.Location of the atresia was in ascending colon （n=3）,hepatic flexure （n=2）,transverse colon （n=8）,lower colon （n=2）,spleenic flexure （n=2）and sigmoid colon （n=1）.According to categories of the atresia,Ⅲ （n=14）,Ⅰ（n=2）,Ⅱ（n=2）.14 cases received stage I anastomosis,3 Sigmoid colosto-my,and 1gave up treatment.2 patients died. Conclusion When the the atresia is in the proximal colon,ileo-colic anastomosis should be adopted.When the blind side of atresia is beyond the splenic flexure,the ileo-cecal valve and part of the proximal colon should be retained and colocolic anastomosis should be adopted. When the blind side of atresia is beyond the sigmoid colon or with poor general condition,enterostomy should be adopted.