Zhu Haiwei,Lan Qingnan,Zhong Jianhua,et al.Post-cardiotomy colonic stenosis in infants: one-stage intervention and comprehensive literature analysis[J].Journal of Clinical Pediatric Surgery,2026,(01):70-74.[doi:10.3760/cma.j.cn101785-202410038]
一期手术治疗婴幼儿先天性心脏病手术后结肠狭窄2例并文献分析
- Title:
- Post-cardiotomy colonic stenosis in infants: one-stage intervention and comprehensive literature analysis
- Keywords:
- Congenital Heart Disease; Cardiopulmonary Bypass; Gastrointestinal Complications; Surgical Procedures; Operative; Neonatal Screening
- 摘要:
- 目的 探讨婴幼儿先天性心脏病手术后胃肠道并发症的临床特征及治疗方法。方法 回顾性分析2024年7月至2024年8月东莞市第八人民医院收治的2例法洛四联症手术后结肠狭窄患儿的临床资料,分析其临床特征、诊断要点及治疗方案,以“先天性心脏病(congenital heart disease; CHD)”、“心脏手术(heart surgery)”、“体外循环(cardiopulmonary bypass,CPB)”、“胃肠道并发症(gastrointestinal complications)” 、“婴幼儿(infant)”、“儿童(child)”为关键词,在知网、万方医学网、维普、PubMed等数据库进行文献检索,时间范围为1995年1月至2024年8月,并对相关文献进行复习、归纳和总结。结果 本院收治的2例患儿均为6月龄以上,首发症状为体外循环法洛四联症手术后反复腹胀、呕吐,通过胃肠道超声、结肠造影、肠镜检查确诊,通过“腹腔镜探查+一期手术”切除狭窄肠管、肠吻合后治愈,未出现肠瘘、腹腔感染、肠梗阻等并发症,术后随访6个月,喂养、生长发育状况明显改善。检索出符合纳排标准的文献2篇(共报道4例患儿),包括本院在内共6例,年龄33天至4岁。心脏病类型:房间隔缺损合并室间隔缺损2例,法洛四联症4例;并发症:坏死性小肠结肠炎1例,肠穿孔3例,结肠狭窄2例;行肠造瘘术3例,肠切除肠吻合术3例;6例术后均存活。结论 婴幼儿先天性心脏病手术后胃肠道并发症少见,缺血、微循环障碍是主要致病机制,临床表现不典型,可通过胃肠超声、结肠造影、肠镜检查等作出诊断。根据并发症类型及时治疗,效果良好。
- Abstract:
- Objective To explore the clinical characteristics and therapeutic approaches for gastrointestinal complications after congenital heart disease (CHD) surgery in infants. Methods A retrospective analysis was conducted for two children of colonic stenosis after tetralogy of Fallot repair operated from July 2024 to August 2024.Clinical features,diagnostic criteria and treatment protocols were reviewed.Literature searches were performed in China National Knowledge Infrastructure (CNKI),WANFANG,VIP and PubMed by keywords:"Congenital heart disease (CHD)," "Heart surgery," "Cardiopulmonary bypass (CPB)," "Gastrointestinal complications," "Infant," and "Child," covering publications from January 1995 to August 2024.And the relevant studies were systematically reviewed. Results Both cases (aged >6 month) presented with recurrent abdominal distension and vomiting post-CPB surgery.Diagnosis was confirmed via gastrointestinal ultrasonography,colon contrast imaging and endoscopy.Both were successfully managed with laparoscopic exploration followed by one-stage resection of stenotic bowel and anastomosis without complications (e.g.,enteric fistula,intra-abdominal infection or obstruction).During 6-month follow-ups,feeding and growth significantly improved.Literature review identified 2 eligible articles reporting 4 cases.Combined with our cases (total n=6),patient age ranged from 33 days to 4 years.Cardiac diagnoses included atrial/ventricular septal defects (n=2) and tetralogy of Fallot (n=4).Complications were necrotizing enterocolitis (n=1),intestinal perforation (n=3) and colonic stenosis (n=2).Surgical interventions comprised enterostomy (n=3) and bowel resection with anastomosis (n=3) with 100% survival. Conclusions Gastrointestinal complications after CHD surgery are rare in infants.Major causes are ischemia and microcirculatory dysfunction.For non-specific clinical manifestations,multimodal imaging of gastrointestinal ultrasound,contrast studies and endoscopy is required for a definite diagnosis.Timely interventions tailored to complication types may achieve favorable outcomes.
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备注/Memo
收稿日期:2024-10-16。
基金项目:2023年度东莞市社会发展重点支持项目(20231800939942)
通讯作者:曲志博,Email:zhiboqu@126.com