肠造瘘术在早产儿急腹症治疗中的应用

Application of enterostomy in the treatment of acute abdomen in premature infants

目的:总结肠造瘘术在早产儿急腹症治疗中的临床疗效。方法:回顾分析南京医科大学附属妇产医院2021年3月至2022年2月收治的因急腹症行肠造瘘术的22例早产儿病例资料,统计术后30 d存活率,记录造瘘口排便时间、术后静脉营养时间、术后体重增长情况以及相关并发症情况。结果:本组22例患儿术后存活19例,死亡3例。存活患儿术后肠功能逐渐恢复,造瘘口排便良好;术后腹腔感染得到有效控制,术后1周白细胞及C反应蛋白基本恢复正常;术后静脉营养支持逐渐向肠内营养过渡,患儿体质量增长满意;术后并发症情况:5例出现造瘘口周围皮肤炎,4例发生造瘘口回缩,2例发生造瘘肠管侧壁瘘,1例出现造瘘口高流量腹泻,1例并发小肠坏死伴穿孔行非计划二次手术。结论:肠造瘘术作为早产儿急腹症的过渡治疗手段,近期效果良好,但要注重术后营养支持及综合管理,并重视术后并发症的处理,才能提高患儿生存率,进而提高最终治愈率。

Objectve:To summarize the clinical effect of enterostomy in the treatment of acute abdomen in premature infants.Methods:The data of 22 premature infants who underwent enterostomy for acute abdomen from March 2021 to February 2022 in the Women’s Hospital of Nanjing Medical University were retrospectively analyzed.The survival rate at 30 days after operation was counted,and the defecation time of stoma,postoperative intravenous nutrition time,postoperative weight gain and related complications were recorded.Results:19 infants survived and 3 infants died after operation.The surviving children had gradual recovery of intestinal function and smooth defecation at the stoma after operation;postoperative abdominal infection was effectively controlled,white blood cells and C-reactive protein basically returned to normal one week after operation;relying on intravenous nutritional support,they gradually transitioned to enteral nutrition,and the weight gain was satisfactory;postoperative complications:5 cases had peristomal dermatitis,4 cases had stoma retraction,2 cases had stoma lateral wall fistula,1 case had stoma high-flow diarrhea,1 case was complicated with intestinal necrosis and performed for unplanned second operation.Conclusion:Enterostomy,as a transitional treatment for premature acute abdomen,has a good short-term effect.However,we should pay attention to postoperative nutritional support and comprehensive management,postoperative complications need to be properly managed,so as to improve the survival and ultimately cure rates.