小肠内置管肠排列术治疗婴幼儿粘连性小肠梗阻的远期临床效果

Long-term clinical effect of internal stenting for adhesive small bowel obstruction in infants

目的探讨小肠内置管肠排列术在婴幼儿粘连性小肠梗阻中的远期临床效果。方法回顾性分析2012年1月到2015年12月间郑州大学第三附属医院收治的67例粘连性小肠梗阻患儿行小肠内置管肠排列术治疗的临床资料。其中,男46例,女21例;年龄(343.3±279.7)d;既往腹部手术次数(1.1±0.6)次。术中顺行置管51例(76.1%),逆行置管16例(23.9%)。统计本组患儿术中情况、置管相关并发症及肠梗阻复发率。结果67例患儿均接受小肠内置管肠排列术,院内死亡3例(4.5%)。其中1例为早产儿、极低体重儿,胎粪性腹膜炎、肠穿孔患儿,术后家属放弃治疗,死于弥散性血管内凝血(disseminated intravascular coagulation,DIC)、感染性休克;另2例均为早产儿、低体重儿、新生儿坏死性小肠结肠炎患儿,术后家属放弃治疗,死于呼吸功能衰竭。余64例患儿术后平均禁食水时间2.6 d,平均置管时间21.6 d。除失访7例外,余57例均获随访,随访时间(78.3±12.5)个月。复发肠梗阻4例(7.0%),3例梗阻复发后均再次行小肠内置管肠排列术,1例梗阻复发后行肠切肠吻合术、肠粘连松解术。4例均术后恢复良好,顺利出院,长期随访均未再次出现梗阻复发。术后发生置管相关并发症2例(3.1%),包括拔管困难1例,给予分次拔除肠排列管;拔管后出现小肠套叠1例,保守治疗后治愈。结论小肠内置管肠排列术是治疗婴幼儿粘连性小肠梗阻的有效手术方式,术后肠梗阻复发率及置管相关并发症发生率低。

Objective To explore the long-term clinical effect of internal stenting for adhesive small bowel obstruction(ASBO)in infants.Methods From January 2012 to December 2015,retrospective analysis was performed for clinical data of 67 children of ASBO undergoing small bowel intestinal arrangement.There were 46 boys and 21 girls with an age range of(343.3±279.7)days.The number of previous abdominal operations was(1.1±0.6)times.Internal stenting(n=51,76.1%)and retrograde(n=16,23.9%)were performed.Statistical analysis was conducted for intraoperative findings,catheter-related complications and recurrence rate of intestinal obstruction.Results Among them.there were 3 in-hospital deaths(4.5%).One case was premature,another had a very low birth weight while a third developed meconium peritonitis and intestinal perforation.The latter died from disseminated intravascular coagulation(DIC)and septic shock.Another 2 infants were premature with a low birth weight and neonatal necrotizing enterocolitis.Family members gave up postoperative measures and both died of respiratory failure.The average postoperative fasting time for the remainders was 2.6 days and the average indwelling time 21.6 days.Except for 7 children lost to follow-ups,all 57 children were followed up for(78.3±12.5)months.Four cases(7.0%)of recurrent intestinal obstruction and 3 children with recurrent obstruction all underwent internal re-stenting.One child with recurrent obstruction underwent intestinal resection,intestinal anastomosis and intestinal adhesion lysis.All 4 children recovered well postoperatively and were discharged without any recurrent obstruction during long-term follow-ups.Intubation-related complications occurred in 2 cases(3.1%),including difficulty extubation(n=1)and staged removal of intestinal arrangement tube(n=1).One case of small bowel intussusception after extubation was cured after conservative measures.Conclusion Internal stenting is an effective treatment for adhesive small bowel obstruction(ASBO)in infants.It has a low recurrence rate and a low incidence of catheter-related complications.