单中心先天性小肠闭锁不同手术方式疗效分析

Therapeutic effect of different surgical methods for congenital small intestine atresia

目的对比分析3种手术方式在治疗小肠闭锁中的疗效,为小肠闭锁患儿个体化手术治疗提供依据。方法回顾性分析福建省妇幼保健院2008年1月至2017年9月168例小肠Ⅱ、Ⅲ、Ⅳ型闭锁患儿临床诊治资料,按术式不同分为3组:端端吻合组(58例)、端斜吻合组(68例)、近端裁剪端端吻合组(42例),端端吻合组和端斜吻合组又分为近端肠管口径>远端4倍a组,≤远端肠管口径4倍的b组。对比分析各组患儿性别、胎龄、出生体重、肠闭锁类型及术后排便时间、术后进食时间、术后住院时间及术后随访半年并发症情况。结果各组患儿性别、胎龄、出生体重、肠闭锁类型对比差异无统计学意义(P>0.05),近端裁剪端端吻合组在术后排便时间、术后进食时间、术后住院时间及并发症情况均优于端端吻合a组和端斜吻合a组(P<0.05)。术后排便时间、术后进食时间、术后住院时间及并发症情况端斜吻合a组优于端端吻合a组(P<0.05),端端吻合b组和端斜吻合b组在术后排便时间、术后进食时间、并发症情况对比差异无统计学意义(P>0.05),但术后住院时间端端吻合b组长于端斜吻合b组(P<0.05)。结论对于近端肠管口径>远端4倍的患儿,建议行近端肠管裁剪端端吻合手术,有术后恢复迅速、并发症更少的优点;对于近端肠管口径≤远端4倍的患儿,建议行端斜吻合手术,较端端吻合手术有住院时间更短的优点。先天性小肠闭锁根据患儿具体的情况选择合适的手术方式,具有更好的疗效。

Objective To compare and analyze the curative effect of three surgical methods in the treatment of small intestine atresia,and to provide evidence for individualized surgical treatment of children with small intestine atresia.Methods The clinical diagnosis and treatment of 168 children with small intestineⅡ,Ⅲ,Ⅳtype atresia in our hospital from January 2008 to September 2017 were retrospectively analyzed and they were divided into different types according to the operation.The three groups were end-to-end anastomosis group(EEA,n=58),end oblique anastomosis group(EOA,n=68),and proximal end-end anastomosis group(PEA,n=42).The EEA group and the EOA group were further divided into group a(EEA-a/EOA-a)with a proximal intestinal tube diameter greater than 4.0 times the distal end and a group b((EEA-b/EOA-b)with a diameter less than or equal to 4.0 times the distal intestinal tube diameter.The gender,gestational age,birth weight,type of atresia,and postoperative defecation time,postoperative feeding time,postoperative hospital stay and postoperative follow-up complications were compared.Results There was no significant difference in gender,gestational age and birth weight between the groups(P>0.05).The PEA group was better than EEA-a group and EOA-a group in postoperative defecation time,postoperative feeding time,postoperative hospital stay and complications(P<0.05).The postoperative defecation time,postoperative feeding time,postoperative hospital stay and complications of the EOA-a group were better than those of the EEA-a group(P<0.05).There was no statistically significant difference in postoperative defecation time,postoperative feeding time,and complications between the EEA-b group and the EOA-b group(P>0.05),but the postoperative hospital stay in the EEA-b group was longer than that in the EOA-b group(P<0.05).Conclusion PEA is recommended for children with a proximal intestinal canal diameter greater than 4.0 times greater than the distal end because of the rapid recovery and fewer complications;EOA is recommended for children with a proximal intestinal canal diameter of 4.0 or less because of its advantage of shorter hospital stay than EEA surgery.Congenital intestinal atresia has a better effect according to the specific conditions of the child.