Wu Caiwei,Yang Shaobo,Zhu Haitao,et al.Investigation on the colostomy style of high anorectal malformation[J].Journal of Clinical Pediatric Surgery,2019,18(06):480-483,497.[doi:10.3969/j.issn.1671-6353.2019.06.009]
先天性高位肛门直肠畸形不同结肠造瘘方式的对比研究
- Title:
- Investigation on the colostomy style of high anorectal malformation
- Keywords:
- Digestive System Abnormalities; Colostomy/MT
- 分类号:
- R726.2;R657.1+1
- 摘要:
- 目的 比较先天性高位肛门直肠畸形新生儿期结肠袢式造瘘术、乙状结肠分离式造瘘术及其改良术式的优缺点。方法 回顾性分析复旦大学附属儿科医院2007年6月至2017年6月收治的148例先天性高位肛门直肠畸形肠造瘘患儿的临床资料，其中男童115例，女童33例，平均出生体重为（3 240±572）g，平均胎龄（38.07±1.1）周，根据造瘘方式分为3组：A组采取结肠袢式造瘘（A1组：横结肠袢式造瘘术；A2组：乙状结肠袢式造瘘术）；B组采取乙状结肠分离、远端缩窄式造瘘；C组采取单纯乙状结肠分离式造瘘。对各组手术时间、造瘘口脱垂、造瘘口内陷、远端粪石残留、Ⅱ期术前评估及手术难易等资料进行总结。结果 3组患儿出生体重、胎龄、手术时间比较差异无统计学意义（P>0.05）。A1组术前行远端肠造影成功仅3例（20.0%），A2组术前远端造影成功4例（66.7%），B组术前行远端肠造影成功46例（79.3%），C组术前行远端肠造影成功20例（62.5%），差异有统计学意义（χ2=18.834，P<0.001）。B组出现远端造瘘口闭塞3例，A、C组未出现远端闭塞病例。所有患儿于二期肛门成形术中发现直肠盲端积粪扩张16例，其中A1组13例，A2组3例；B组和C组均未发现直肠盲端积粪扩张，3组远端肠管积粪扩张发生率比较差异有统计学意义（χ2=45.276，P < 0.05）。A组中有5例发生腹壁伤口感染，而B、C组各有1例发生腹壁伤口感染，3组腹壁伤口感染率比较，差异有统计学意义（χ2=6.745，P < 0.05）。A组有1例出现造瘘口肠管脱垂，该例无肠管内陷；B组有3例出现造瘘口肠管脱垂，脱垂肠管为近端；C组有2例出现造瘘口肠管脱垂，均为造瘘近端肠管。3组肠管脱垂发生率比较差异无统计学意义（χ2=0.426，P=0.808）。结论 新生儿期先天性肛门闭锁单纯乙状结肠分离式造瘘效果优于结肠袢式造瘘及乙状结肠分离远端缩窄的造瘘方式。乙状结肠近降结肠处造瘘，可降低二期手术难度。
- Abstract:
- Objective To compare the advantages and disadvantages of loop colostomy and sigmoid colon isolated ostomy for congenital high anorectal malformation. Methods Retrospective analysis was performed for 148 cases of congenital high anorectal malformations from June 2007 to June 2017. There were 115 boys and 33 girls with a mean birth weight of (3 240±572) grams and a mean gestational age of (38.07±1.1) weeks. They were divided into 3 groups according to ostomy style:group A of loop colostomy (A1 in transverse colon,A2 in sigmoid colon),group B of sigmoid colon isolated ostomy with distal intestinal bowel narrowing and group C of sigmoid colon isolated ostomy. The operative duration,postoperative complications,preoperative evaluation of stage Ⅱ surgery of each group were analyzed. Results No differences existed in birth weight,gestational age and operation time of ostomy among 3 groups (P>0.05). Visualization success of distal bowel occurred before stage Ⅱ surgery in group A1 (n=3,20.0%),group A2 (n=4,66.7%),group B (n=46,79.3%) and group C (n=20,62.5%). The difference was statistically significant among 3 groups in visualization success rate of distal bowel (χ2=18.834,P<0.001). Distal ostomy occluded in group B (n=3) and no distal ostomy occlusion in group A/C. Distal intestinal bowel stercoroma and secondary expansion occurred in group A (n=13,group A1; n=3,group A2) and no distal intestinal bowel stercoroma in group B/C. The difference was statistically significant in distal intestinal bowel stercoroma and secondary expansion among 3 groups (χ2=45.276,P<0.05). Incision infection occurred in group A (n=5),group B (n=1) and group C (n=1). And the difference was statistically significant among 3 groups (χ2=6.745,P<0.05). Bowel prolapse occurred in group A (n=1),group B (n=3) and group C (n=2). And no significant difference existed in bowel prolapse among 3 groups (χ2=0.426,P=0.808). Conclusion The effect of sigmoid colon isolated ostomy is better than that of loop colostomy and sigmoid colon isolated ostomy with distal intestinal bowel narrowing. Sigmoid colon ostomy close to descending colon avoids the difficulty of stage Ⅱ operation.
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备注/Memo
收稿日期:2018-02-12。
通讯作者:陈功,Email:chengongzlp@hotmail.com