Xie Xiaoli,He Qiuming,Zhong Wei,et al.14 cases of chronic pseudo intestinal obstruction with onset in neonatal period: programmed surgical treatment and prognosis analysis mainly based on ileal double lumen stoma[J].Journal of Clinical Pediatric Surgery,2025,(12):1127-1133.[doi:10.3760/cma.j.cn101785-20251126-00090-007]
新生儿期起病慢性假性肠梗阻14例:回肠双腔造口为主的程序化外科治疗与预后分析
- Title:
- 14 cases of chronic pseudo intestinal obstruction with onset in neonatal period: programmed surgical treatment and prognosis analysis mainly based on ileal double lumen stoma
- Keywords:
- Chronic Intestinal Pseudo-obstruction; Surgical Intervention; Surgical Treatment; Unplanned Reoperation; Prognosis
- 摘要:
- 目的 初步总结新生儿期起病的儿童慢性假性肠梗阻(pediatric intestinal pseudo-obstruction,PIPO)患儿临床特点、外科治疗经验及预后,探讨其程序化外科处理策略。方法 本研究为回顾性病例系列研究,分析2016年7月至2025年6月广州市妇女儿童医疗中心收治的14例新生儿期起病的PIPO患儿临床资料,收集患儿手术方式、术后并发症、非计划再手术率、营养支持方式、营养状况及生存情况。结果 14例患儿共接受手术治疗36次,单例中位手术次数为2.6次。除1例仅行膀胱造口术以外,其余13例均接受肠造口术,其中1例同时行经皮空肠营养管置管术,1例同时行经皮空肠营养管置管术及经皮回肠营养管置管术。13例肠造口患儿中,11例首次手术为回肠双腔造口,1例为Santulli造口,1例为Bishop-Koop造口。共7例因术后再发肠梗阻经保守治疗无效而接受非计划再次手术。首次手术为T型造口的2例(T型造口包括Santulli造口和Bishop-Koop造口)均接受非计划再次手术,而首次手术行双腔造口的11例中,5例(45.5%)接受非计划再次手术。14例平均随访时间36.2个月(范围:2~83个月),存活12例(85.71%),其中1例未行肠造口,5例已关瘘(平均关瘘年龄为30.4个月),6例仍保留肠造口(4例为回肠双腔造口状态;2例为回肠Bishop-Koop造口,其中1例经皮留置空肠营养管)。8例完全经口饮食,1例经空肠营养管持续喂养,2例经鼻胃管持续喂养同时需部分静脉营养支持,1例需完全静脉营养支持。8例营养状况正常,4例存在不同程度的营养不良。死亡2例(14.29%)。结论 对于新生儿期起病的PIPO,首次手术时选择行回肠双腔造口术、延期关瘘,可能有利于避免早发型PIPO病例的非计划再次手术。个体化营养支持方式可以有效避免PIPO患儿出现营养不良。
- Abstract:
- Objective To summarize the clinical characteristics,surgical treatment experience,and prognosis of children with chronic intestinal pseudo-obstruction (PIPO) with neonatal onset,and to explore a standardized surgical management strategy. Methods A retrospective study was conducted to analyze the clinical data of 14 children with neonatal-onset PIPO treated at the Women and Children’s Medical Center from July 2016 to June 2025.Observational indicators included surgical procedures,postoperative complications,unplanned reoperation rate,nutritional support modalities,nutritional status,and survival outcomes. Results The 14 patients underwent a total of 36 surgical procedures,with a median of 2.6 operations per patient (range:0-5).Except for one patient who underwent cystostomy alone,the remaining 13 patients underwent enterostomy; among them,one patient additionally received percutaneous jejunal feeding tube placement,and another patient received both percutaneous jejunal and ileal feeding tube placement.Among patients who underwent enterostomy,the initial procedure was double-barrel ileostomy in 11 cases,Santulli enterostomy in 1 case,and Bishop-Koop enterostomy in 1 case.A total of 7 patients required unplanned reoperation due to recurrent postoperative intestinal obstruction that failed conservative treatment.Both patients whose initial procedure was a T-type enterostomy (including Santulli and Bishop-Koop enterostomy) (100%) required unplanned reoperation,whereas 5 of the 11 patients (45.5%) who initially underwent double-barrel enterostomy required unplanned reoperation.The mean follow-up duration was 36.2 months (range:2-83 months); among them,one did not undergo enterostomy,five had stoma closure (mean age at closure:30.4 months),and six retained enterostomies (four with double-barrel ileostomy and two with Bishop-Koop ileostomy,one of whom had a percutaneous jejunal feeding tube in place).Eight patients were on full oral feeding,one required continuous jejunal tube feeding,two required continuous nasogastric feeding with partial parenteral nutrition support,and one required total parenteral nutrition.Nutritional status was normal in eight patients,while four had varying degrees of malnutrition.Two patients died (14.29%). Conclusions For neonatal-onset PIPO,selecting double-barrel ileostomy as the initial surgical procedure with delayed stoma closure may help reduce the need for unplanned reoperation in early-onset PIPO cases.Individualized nutritional support strategies can effectively prevent malnutrition in children with PIPO.
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备注/Memo
收稿日期:2025-11-10。
基金项目:国家自然科学基金项目(82301343、82370526);广州市科技计划项目(2025A03J4456)
通讯作者:钟微,Email:zhongwei@gwcmc.org