蕈式引流管在小儿回肠末端穿孔原位造瘘四例分析

Application of mushroom type drainage tube in children with terminal ileum perforation： a report of 4 cases

目的 探讨蕈式引流管造瘘在小儿回肠末端穿孔中应用的可行性和安全性.方法 回顾性分析2015年1月1日至2015年5月31日,收住的4例急腹症患儿（均为男孩,年龄最小6个月,最大2岁9个月）,我们采取急诊剖腹探查术,术中均发现有回肠末端穿孔,穿孔距离距回盲部从1.5cm至3cm不等,术中我们均采用了蕈式引流管经回肠末端穿孔原位造瘘.结果 本组4例患儿均在术后第一天和第二天有发热,体温38.0℃以下,第三天正常,且有肛门排气、排便,肠蠕动恢复,第四天拔出胃管给予流食,第六天正常饮食,因为采用了减张缝合,平均住院2周,住院期间,蕈式引流管远端和引流袋连接,有少量稀水便和气体排出,使用蕈式引流管体外造瘘均痊愈出院,出院后2个月复查,患儿饮食及大小便正常,引流管无明显粪便排出,经体表拔出引流管,再经1周体表皮肤愈合,随访半年,未出现相关并发症.结论 小儿回肠末端穿孔（距回盲部约10 cm）采取一期吻合困难的患儿,常规采用回肠远端封闭,回结肠吻合;回盲部切除,回结肠吻合,或者采用穿孔修补,其近段回肠造瘘,这几种术式造成的并发症严重影响了小儿的生理、心理发育.然而蕈式引流管在回肠末端穿孔中的应用使回盲部免予切除,使患儿免于回肠造瘘后并发症的影响及第二次手术带了的双重打击,因此值得临床探讨及推广应用.

Objective To explore the feasibility and safety of applying mushroom type drainage tube fistula in pediatric terminal ileal perforation.Methods From January 1,2015 to May 31,2015,we collected the clinical data of mushroom type drainage tube from 4 cases of ileal perforation and retrospective analysis was performed.During emergency laparotomy,terminal ileum perforation was identified.And the distance was 1.5 to 3 cm away from perforation.All patients were boys aged 6-33 months.Results Four cases had a fever of 〈38 ℃ at Day 1 and 2 post-operation.At Day 3,fever disappeared with anal exhaust,normal defecation and intestinal peristalsis.At Day 4,gastric tube was extracted and a liquid diet was offered.At Day 6,there was a normal diet.Because of relaxation suture,the average length of stay was 2 weeks.During hospitalization,mushroom type drainage tube was connected to a distal drainage bag.A small amount of water was discharged with gas exhaust.All patients were cured and discharged after 2 months.During re-examinations at 2 months,diet,stool and urine were normal.Drainage tube had no obvious fecal discharge.After extraction at 1 week,body surface skin healed.During a follow-up period of 6 months,there was no relevant complication.Conclusions Terminal ileum perforation （around 10 cm away from ileocecus） can not be cured by one-stage anastomosis.The conventional approaches include distal ileum closure,ileum-colon anastomosis;resection of ileocecus,ileum-colon anastomosis,perforation repair and proximal ileum-colon anastomosis.All of the above complications had negative effects on physical and mental developments of children.However,mushroom type drainage tube may avoid resection of ileocecus for ileum perforation.Thus ileostomic complications and adverse outcomes of two-stage surgery are prevented.It is worthy of wider clinical applications.