儿童消化道择期手术后非计划再手术原因分析及其预后

Causes of unplanned reoperation in pediatric patients undergoing elective digestive tract surgery and the prognosis

目的分析儿童消化道择期手术患儿术后发生非计划再手术的原因及其预后。方法回顾性分析2012年1月至2019年12月北京儿童医院普外科39例消化道择期手术后发生非计划再手术患儿的临床资料,分析原发疾病诊断、首次术式及手术级别、非计划再手术原因、非计划再手术术式以及患儿的预后。结果39例患儿的原发病包括胆道疾病、肛门和结直肠疾病及小肠疾病,其中二级手术4例(10%),三、四级手术35例(90%)。首次术式包括胆道-小肠手术19例(49%),单纯小肠手术11例(28%),肛门和结直肠手术9例(23%)。非计划再手术的直接原因包括吻合口漏(胆-肠、肠-肠)10例(26%),粘连性肠梗阻8例(20%),术后小肠套叠5例(13%),切口并发症(感染、裂开、切口疝)5例(13%),术后出血3例(8%),其他(首次手术损伤、术式选择缺陷)8例(20%)。术后24例患儿(62%)痊愈出院,9例患儿(23%)因非计划再手术导致需要进一步手术治疗,5例患儿(13%)死亡,1例(3%)发生短肠综合征。结论儿童消化道择期手术后非计划再手术大多发生于复杂手术,非计划再手术最常见的直接原因为吻合口漏、粘连性肠梗阻,非计划再手术对患儿的预后造成不良影响。

Objective To analyze the causes of unplanned reoperation in pediatric patients after elective digestive tract surgery and the prognosis.Methods Medical records were reviewed from pediatric patients undergoing unplanned reoperation after elective digestive tract surgery at our department from Jan 2012 to Dec 2019.Primary diagnoses,procedures and levels of index surgeries,causes and procedures of unplanned reoperations,and patients'prognosis were analyzed.Results There were 39 cases,and the primary diagnoses included biliary disease,anal and colorectal disease,and intestinal disease.There were 4(10%)cases of levelⅡsurgeries,and 35(90%)cases of levelⅢ&Ⅳsurgeries.The index surgical procedures included 19(49%)biliary-intestinal procedures,11(28%)simple intestinal procedures,and 9(23%)anal and colorectal procedures.The direct causes of unplanned reoperation included 10(26%)anastomotic leakages,8(20%)adhesive intestinal obstructions,5(13%)postoperative intussusceptions,5(13%)incisional complications(infection,dehiscence and incisional hernia),3(8%)postoperative hemorrhages and 8(20%)miscellaneous(iatrogenic injury and surgical misjudgment).Patients'prognosis included 24(62%)full recoveries,9(23%)further operations,and 5(13%)deaths,and 1(3%)short bowel syndrome.Conclusions Most pediatric unplanned reoperations after elective digestive tract surgery occur in complex surgical procedures.The most common causes of unplanned reoperation are anastomotic leakage,adhesive intestinal obstruction.Unplanned reoperations are often prone to adverse effects on prognosis.