小儿先天性肠闭锁手术方式的效果比较分析

Analysis of Comparison of Effect of Congenital Intestinal Atresia Surgery in Children

目的分析小儿先天性肠闭锁不同手术方式的效果,为选择个性化治疗方案提供参考。方法回顾性分析该院2014年1月—2016年12月收治的42例先天性肠闭锁患儿资料,观察患儿不同Grosfeld分型、闭锁类型、手术方式的效果和并发症。结果 42例患儿治愈率为85.71%,Grosfeld Ⅰ型、Ⅱ型治愈率均为100.00%,显著高于Ⅲ型、Ⅳ型的69.23%、33.33%(P<0.05)。回肠闭锁、空肠闭锁治愈率分别为78.95%、83.33%,低于十二指肠和结肠闭锁的100.00%、100.00%(P<0.05)。术后并发症发生率为19.05%。扩张肠管切除、端端吻合术痊愈率为85.71%,十二指肠侧侧吻合术痊愈率为100.00%,十二指肠空肠侧侧吻合术痊愈率为100.00%,隔膜切除,肠管纵切横缝合术痊愈率为83.33%,造瘘术痊愈率为100.00%,经秩和检验差异无统计学意义(P>0.05)。结论小儿先天性肠闭锁应根据肠闭锁临床表现、闭锁部位、Grosfeld分型及术中肠管活力、保留长度等确定个性化手术方式,以获得良好的手术效果。

Objective To analyze the effect of different operation methods in congenital intestinal atresia surgery in children and provide reference for the selection of individual treatment plan. Methods 42 cases of children with congenital intestinal atresia in our hospital from January 2014 to December 2016 were selected and the Grosfeld type, atresia type, operation effect and complications of children were observed. Results Of 42 cases, the cure rate was 85.71%, and the cure rate of children of Grosfeld Ⅰ type andⅡ type was 100% and 100%, which were obviously higher than those of children of Ⅲ type and Ⅳ type（69.23% and 33.33%）,（P〈0.05）, and the cure rate of atresia of ileum and jejunum was lower than that of duodenum and colonic atresia（78.95%,83.33% vs 100.00%,100.00%）,（P〈0.05）, and the incidence rate of postoperative complications was 19.05%, and the cure rate of dilated loop incision and end-to-back anastomose was 85.71% and the cure rate of duodenum side-to-side anastomoses and duodenum jejunal side-to-side anastomoses was 100.00% and 100.00%, and the cure rate of intestinal duct longitudinal incision and transverse and nephrostomy was 83.33% and 100.00%, and the difference was not statistically significant（P〈0.05）. Conclusion The congenital intestinal atresia in children should determine the individual operation method according to the clinical manifestations of intestinal atresia, atresia site, Grosfeld type and intraoperative intestinal duct vitality thus obtaining a good operation effect.