小肠插管式造瘘术在难治型小肠闭锁中的应用

Application of small intestine intubate enterostomy in refractory intestinal atresia

目的 探讨闭锁肠段切除肠吻合、小肠插管式造瘘术在难治型小肠闭锁中的应用。方法选择2015年6月-2017年6月在本院接受闭锁肠段切除肠吻合、小肠插管式造瘘术治疗的20例难治型小肠闭锁新生儿作为研究对象。其中男15例,女5例,患儿闭锁近端肠管和闭锁远端肠管直径之比均>4,其中高位空肠闭锁9例(45%),闭锁Ⅲb型6例(30%),闭锁Ⅳ型5例(25%),合并复杂型胎粪性腹膜炎15(75%),因并发症再次手术的3例。结果 全组均完成小肠插管式造瘘术,其中手术时间2 h(1.5~3.0h),术中出血量5 ml(3~15 ml)。术后并发症发生率15%,其中胆汁淤积征1例,坏死性小肠结肠炎1例,粘连性肠梗阻1例,再次手术死亡。其余19例患儿术后进食时间10 d(6~20 d),术后住院间30 d(15~50d),住院费用3.8万元(3~5.5万元),恢复良好。结论 闭锁肠段切除肠吻合、小肠插管式造瘘术操作相对简单,疗效满意,避免二次手术的风险。

Objective To explore the application of atresia intestinal resection and anastomosis and small intestine intubate enterostomy in refractory intestinal atresia.Methods A total of 20 neonates with refractory intestinal atresia underwent atresia intestinal resection and anastomosis and small intestine intubate enterostomy in our hospital from June 2015 to June 2017 were selected as study subjects.Among which,15(75%)cases were male and 5(25%)cases were female.Diameter ratio of proximal atretic intestinal canal to distal atretic intestine was all greater than 4.There were nine cases of high jejunal atresia,6 cases of type III b atresia,5 cases of typeⅣatresia,and 15 cases were identified as complex meconium peritonnitis,and 3 cases received reoperation.Results All the cases completed their small intestine intubate enterostomy operations successfully,with median operative time of 2(1.5~3.0)hours and median intra-operative blood loss of 5(3~15)ml.The postoperative complication rate was 15%,including 1 case of cholestasis,1 case of neonatal necrotizing enterocolitis,1 case of ileus who died after reoperation.For the rest 19 neonates,the mediam first feeding time was 10(6~20)days,the median hospital stay was 30(15~50)days,the median hospitalization expenses was 3.8(3~5.5)ten thousand yuan,they recovered well.Conclusions Atresia intestinal resection and anastomosis and small intestine intubate enterostomy is simple and feasible in the treatment of neonates with refractory intestinal atresia,and could avoid risk of reoperation.