小肠内置管排列术治疗新生儿粘连性肠梗阻

Intestinal intubation plication in the treatment of neonatal adhesive intestinal obstruction

目的探讨小肠内置管排列术治疗新生儿粘连性肠梗阻(AI)的方法和疗效。方法按照手术方式不同将2014年2月至2016年2月接诊的84例新生儿AI患儿分为观察组35例和对照组49例,观察组患儿接受小肠内置管排列术治疗,对照组患儿接受常规手术治疗。比较两组患儿预后情况、术后恢复情况,术前及术后4周营养状态变化情况、近期并发症发生情况以及随访2年远期并发症发生情况。结果观察组患者术后肛门排气时间及住院时间均显著短于对照组,有统计学差异(P <0. 01)。术后4周,两组血清白蛋白、血清前白蛋白、转铁蛋白及体质量均高于术前(P均<0. 05);且观察组以上指标均显著高于对照组(P <0. 05)。两组患儿总治愈率和总死亡率比较无统计学差异(P> 0. 05);但观察组一次手术治愈率显著高于对照组(P <0. 01)。观察组患儿术后近期并发症及远期并发症发生率均显著低于对照组,有统计学差异(P <0. 05)。结论小肠内置管排列术治疗新生儿AI疗效明确,一次手术治愈率高,术后并发症少,患儿营养状态更佳,可作为优选术式。

Objective To explore the method and effect of intestinal intubation plication in the treatment of newborn adhesive ileus（AI）. Methods A total of 84 newborn AI from February 2014 to February 2016 were divided into observation group（n = 35） in which intestinal intubation plication was performed and control group（n = 49） in which routine surgical treatment was performed. Before and 4 weeks after operation,the prognosis,postoperative recovery,nutritional change status,incidences of recent complications and long-term complications during 2 years follow-up were compared between two groups. Results The anal exhaust time and hospital stay in observation group were obviously lower than those in control group（P〈0. 01）. At 4 weeks after operation,the serum levels of albumin,prealbumin,transferrin and body weight were significantly higher than those before operation in both two groups（all P〈0. 05） and were statistically higher in observation group than those in control group（all P〈0. 05）. Postoperative complications and incidence of long-term complications in observation group were significantly lower than those in control group（P〈0. 05）. There were no significant differences on the total cure rate and mortality ratebetween two groups（P〉0. 05）,but thecurativeratewithsingleoperationin observation group wasstatistically higher than that in control group（P〈0. 01）. Conclusions Intestinal intubation plication for neonatal AI has a definite curative effect,a higher cure rate with single operation,less postoperative complications and better nutritional status. It can be used as a preferred operation in clinic.