经肠镜置入支撑管治疗新生儿肠吻合术后吻合口狭窄

Treatment of anastomotic stricture after enterostomy in neonates with support tube implantation under colonoscope

目的探讨通过肠镜置入支撑管过吻合口并保留一段时间治疗新生儿肠吻合术后吻合口狭窄避免再次手术时的可行性以及效果。方法回顾性分析2021年1月至2023年2月中国人民解放军总医院第七医学中心经肠镜放置支撑管治疗新生儿肠吻术后吻合口狭窄6例的临床资料,其中男5例,女1例,出生胎龄为27~40周,置入支撑管时平均体重为3.3 kg,体重范围为1.5~4.0 kg。6例包括新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)肠造瘘术后行肠造瘘还纳吻合术患儿2例,先天性肠闭锁患儿2例,肠扭转坏死行肠吻合手术患儿1例,胎粪型腹膜炎吻合术后1例。经肠镜置入支撑管治疗后观察其开奶时间、住院时间、撤离支撑管后肠狭窄治愈时间以及体重增长情况。所有患儿出院后均按时随访6个月。结果所有患儿置管后腹胀均缓解并根据情况逐步喂奶。治疗后开始喂奶平均时间为3.2 d,时间范围为2~8 d;患儿置管后平均住院时间为11.7 d,时间范围为2~15 d;置管后拔管平均时间为45 d,时间范围为28~52 d;置管时平均体重为4.4 kg,体重范围为2.8~5.2 kg;较置管前体重增加平均值为1.1 kg,范围为0.8~1.5 kg。拔出支撑管后,患儿均未再次出现肠狭窄相关的临床表现,随访患儿均无特殊情况。结论经肠镜置入支撑管操作简单易行,能够有效治疗新生儿肠吻合术后吻合口狭窄,可以更快更好地开始肠内营养,达到体重增加的效果,避免了再次手术。

Objective:To explore the feasibility and efficacy of inserting a support tube through anastomosis and maintaining it for some time for treating neonatal anastomosis stenosis for avoiding reoperation.Methods:From January 2021 to February 2023,the relevant clinical data were retrospectively reviewed for 6 children of anastomotic stenosis.There were 5 boys and 1 girl with a gestational age of(27-40)weeks and an average body weight of 3.3(1.5-4.0)kg.The 6 cases included 2 children with neonatal enterostomy and anastomstomy for neonatal necrotizing enterocolitis(NEC,n=2),congenital intestinal atresia(n=2),necrotic intestinal ostomy(n=1)and meconitis anastomosis(n=1).A support tube was placed under colonoscopy.Feeding time,hospitalization stay,healing time of posterior bowel stenosis and weight gain were recorded.The post-discharge follow-up period was 6 months.Results:Abdominal distension appeared after catheterization and feeding resumed gradually according to individual status.Mean time to nursing feeding was 3.2(2-8)day.Mean length of hospitalization after catheterization was 11.7(2-15)day,average time of extubation after catheter placement 45(28-52)day,average body weight 4.4(2.8-5.2)kg and average body weight gain 1.1(0.8-1.5)kg.After tube removal,none had any clinical manifestation related to intestinal stenosis during follow-ups.Conclusion:Inserting a support tube under colonoscopy is simple.Effectively treating anastomotic stenosis after neonatal anastomosis,it may start enteral nutrition faster and better,achieve the goal of body weight gain and avoid reoperation.