T型肠造口术治疗新生儿暂时性短肠综合征

Efficacy of T-type enterostomy for temporary short bowel syndrome in neonates

目的探讨T型肠造口术在新生儿暂时性短肠综合征患者中的治疗效果。方法回顾性分析2008年12月至2021年12月在北京儿童医院新疆医院接受手术治疗的26例新生儿暂时性短肠综合征患儿的临床资料,其中男16例,女10例,手术时日龄为(9.1±2.3)d;根据手术方式不同分为T瘘手术组12例,即Ⅰ期肠造口术(单腔或T型)+Ⅱ期单腔肠造口改T型造口术+Ⅲ期造口还纳术,传统手术组14例,即Ⅰ期肠造口术(单口或双口)+Ⅱ期肠切除肠吻合。对比分析两组患儿造口还纳时间、造口还纳后排便时间、手术并发症和营养状况等指标的差异。结果T瘘手术组患儿手术日龄[(7.5±2.7)d比(10.5±2.2)d]、手术时体质量[(1253±442)g比(1882±190)g]、早产周龄[(28.8±2.3)周比(31.2±1.7)周]、可利用肠管长度[(42.5±9.0)cm比(52.5±7.3)cm]均短于传统手术组患儿,差异均有统计学意义(P<0.05)。T瘘手术组患儿等待造口还纳时间[(12.0±2.8)周比(14.7±2.1)周]、造口还纳后排便时间[(3.8±2.4)d比(7.7±1.1)d]均短于传统手术组,差异均有统计学意义(P<0.05)。T瘘手术组患儿T瘘手术前与造口还纳术前比较,造口还纳术前与造口还纳后6个月比较,前白蛋白和视黄醇结合蛋白有提高(P<0.05)。新型肠造口封堵器封堵造口患儿封堵造口期间无严重并发症发生,封堵效果满意。结论T型肠造口术可以显著改善造口还纳手术等待时间和造口还纳后肠功能恢复时间,减少非计划再手术的发生。

ObjectiveTo explore the therapeutic effect of T-type enterostomy in neonates with temporary short bowel syndrome(SBS).MethodsFrom December 2008 to December 2021,the relevant clinical data were retrospectively reviewed for 26 neonates with temporary SBS undergoing operations.There were 16 boys and 10 girls with a mean age at surgery of(9.1±2.3)days.According to different surgical approaches,they were assigned into two groups of T-fistula surgery(n=12)and traditional surgery(n=14).The differences in fistula closure time,defecation time after closure,surgical complications and nutritional status were compared between two groups.ResultsOperative age[(7.5±2.7)vs(10.5±2.2)days],body weight at surgery[(1253±442)vs(1882±190)g],gestational age[(28.8±2.3)vs(31.2±1.7)weeks]and viable intestinal length[(42.5±9.0)vs(52.5±7.3)cm]of T-fistula group were all shorter than those of traditional surgery group and the differences were statistically significant(P<0.05).Waiting time for fistula closure[(12.0±2.8)vs(14.7±2.1)weeks]and defecation time after closure[(3.8±2.4)vs(7.7±1.1)days]were both shorter in T-fistula group than traditional surgery group and the differences were statistically significant(P<0.05).Comparing T-fistula group before and after closure,and before fistula closure and 6 months after fistula closure,both prealbumin and retinol-binding protein spiked(P<0.05).No serious complications occurred during the closure of ostomy using new small intestine ostomy plug.And ostomy closure outcome was satisfactory.ConclusionT-type enterostomy may significantly shorten waiting time for colostomy closure and time for post-colostomy bowel function recovery and lower the occurrence of unplanned reoperations.