Lai Dengming,Tou Jinfa.Surgical treatment strategies of refractory intestinal atresia[J].Journal of Clinical Pediatric Surgery,2023,22(09):807-812.[doi:10.3760/cma.j.cn101785-202307011-002]
难治型肠闭锁的手术治疗策略
- Title:
- Surgical treatment strategies of refractory intestinal atresia
- Keywords:
- Intestinal Atresia; Surgical Procedures; Operative; Child; Patient Selection
- 摘要:
- 先天性肠闭锁是新生儿外科较为常见的消化道畸形,手术是其唯一的治疗措施。随着新生儿外科诊疗技术、麻醉监护水平和营养管理水平的不断提高,肠闭锁的治疗成功率不断提升。但难治型肠闭锁的治疗仍面临一定的困难,目前并没有统一的治疗方案,可选择以T型造瘘为主的多种手术方式。对于扩张肠管的处理,除适当切除部分肠管外,可采用肠管裁剪成形、内翻折叠或延长成形术;为了促进肠功能恢复,实现早期肠内营养,可采用空肠置管、经阑尾置管或经肛门经回盲部引流;针对Ⅲb型闭锁,可采用多种系膜成形方法,保留更多的远端肠管;采用黏膜下连续缝合的方法,能有效减少吻合口漏的发生;针对肠闭锁伴短肠综合征,需要联合肠内、肠外营养,促进肠道适应。
- Abstract:
- Congenital intestinal atresia (CIA) is a common gastrointestinal malformation in neonates and surgery remains a sole option.With continuous improvements of diagnosis,anesthesia,monitoring and nutritional management,the survival of CIA patients keeps rising.However,managing refractory CIA is still a major challenge.No standardized treatment protocol is available for severe intestinal atresia.A variety of surgical modalities based upon Bishop-Koop or Santulli procedure may be selected.Resection,tapering enteroplasty,varus folding or elongation enteroplasty is indicated for dilated bowel.For promoting intestinal function recovery and early enteral nutrition,jejunal catheterization,transappendixal catheterization or transanal ileocecal drainage may be applied.For type IIIb atresia,a variety of mesangioplasty procedures are applied for retaining distal intestine.Continuous suturing under mucosa offers a better alignment of intestine and lowers the occurrence of anastomotic leakage.For CIA plus short bowel syndrome,supportive enteral parenteral nutrition is required for promoting intestinal adaptation.
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备注/Memo
收稿日期:2023-7-5。
基金项目:国家自然科学基金(82171699);浙江省自然科学基金(Y22H049361)
通讯作者:钭金法,Email:toujinfa@zju.edu.cn