Huang Shengyu,Xie Cheng,Lin Lihua,et al.Application of indwelling catheter through appendix stump fistula in onestage terminal ileectomy.[J].Journal of Clinical Pediatric Surgery,2018,17(04):274-277.
经阑尾残端置管造瘘在小儿一期末段回肠切除术中的应用研究
- Title:
- Application of indwelling catheter through appendix stump fistula in onestage terminal ileectomy.
- Keywords:
- Terminal ileum; Stomal leak; ileocecal valve; Appendix stump fistula; Child
- 文献标志码:
- A
- 摘要:
-
目的 探讨经阑尾残端置管造瘘在小儿一期末段回肠切除术中应用的安全性与实用价
值。 方法 ２００７年１月至２０１６年１２月，本院收治３８例不同病因引起的末段回肠病变患儿，均采用
急诊或亚急诊剖腹探查术，术中均行一期末段病变回肠切除吻合术，吻合口距离回盲瓣１０ｃｍ以内，同
时经阑尾切除的残端置入硅胶管至吻合口近端行回肠造瘘术。 结果 所有病例手术顺利，除末段回
肠闭锁与胎粪性肠梗阻伴末段回肠狭窄的患儿于术后８ｄ及６ｄ肛门及造瘘管排气、排便以外，其余病
例均于术后３～４ｄ肠功能恢复，全部病例于肛门排气排便第２天拔除胃管予流质饮食，１～２ｄ后无腹
胀及呕吐，予半流质饮食，术后４～５ｄ右髂窝引流管未见明显液体引出并经超声检查腹腔无积液后予
拔除引流管，７～１４ｄ腹部探查切口拆线愈合良好，带造瘘管出院，平均住院时间９ｄ。出院后２～５ｄ患
儿饮食及大小便正常，造瘘管无明显粪便排出，在门诊拔除造瘘管，２～３ｄ后瘘口自行愈合。门诊随访
６个月至２年，未见吻合口瘘、吻合口狭窄、腹膜炎、肠粘连及肠扭转等并发症。 结论 小儿末段病变
回肠切除一期回肠吻合术，吻合口距离回盲瓣１０ｃｍ以内，辅以经阑尾残端置硅胶管至吻合口近端行回
肠造瘘术，能有效避免吻合口漏等致命性并发症的发生，且保留了回盲瓣的生理功能，对患儿消化吸收
及生长发育无影响，值得临床推广应用。
- Abstract:
- ObjectiveTo explore the safety and practicality of applying indwelling catheter through appendix stump fistula in onestage terminal ileectomy.MethodsRetrospective analyses were conducted for 38 children hospitalized with terminal ileum diseases from January 2007 to December 2016.After emergency or subemergency laparotomy,onestage terminal ileum excision and anastomosis were performed.And anastomotic stoma was less than 10 cm away from ileocecus.And indwelling silica gel tube was guided through appendix stump fistula into proximal anastomosis.ResultsAll operations were successful.The cases of terminal ileum atresia or terminal ileum stenosis in meconium ileus had anus exhaust at Days 8 and 6.In other cases,postoperative bowel function recovered at Days 3-4.All of them defecated after removing gastric tube and resumed a liquid diet after anus exhaust.And had semiliquid diet without abdominal distention and vomiting after 1-2 days.After no ultrasonic evidence of liquid or seroperitoneum,drainage tube in right iliac fossa elicit was removed at Days 4-5.The incisions healed well at Days 7-14.The average duration of hospitalization was 9 days.Both diet and urine were normal without defecation in fistula at Days 2-5 after discharge.And fistula selfhealed at Days 2-3.During outpatient followups for 6 months to 2 years,there was no occurrence of such complications as anastomotic fistula,anastomotic stricture,peritonitis,intestinal adhesion or volvulus.ConclusionOnestage terminal ileum excision and anastomosis are successful.It can effectively avoid anastomotic leak and retain physiological function of ileocecus.Yet it has no effect upon the growth,digestion and absorption of children.Its worthy of wider clinical application.
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