Wang Kun,Cai Jing,Lu Yingchou,et al.Clinical application of modified enterostomic device during neonatal enterostomy[J].Journal of Clinical Pediatric Surgery,2020,19(01):40-44.[doi:10.3969/j.issn.1671-6353.2020.01.008]
改良式肠造口引流装置在新生儿肠造瘘中的临床应用
- Title:
- Clinical application of modified enterostomic device during neonatal enterostomy
- Keywords:
- Enterostomy; Postoperative Complications; Infant Newborn
- 分类号:
- R726.1;R574.5
- 摘要:
- 目的 探讨改良式肠造口引流装置应用于新生儿肠造瘘手术治疗中的安全性与使用价值。方法 回顾性分析南方医科大学附属东莞市妇幼保健院小儿外科2011年1月至2018年8月收治的45例需行肠造瘘新生儿的临床资料，均采用急诊或亚急诊剖腹探查术进行治疗，术中均实施了暂时性肠造瘘手术，采用随机分配的方法将45例受试者分为传统组（n=27）和改良组（n=18），两组患儿一般临床资料情况对比差异无统计学意义（P>0.05）；改良组术中均在造瘘口的近端采用由包皮环和避孕套组合而成的肠造瘘引流装置，传统组近端造瘘肠管不作处理。对比两组患儿术中出血量、非计划再次手术例数、手术时间、术后住院天数和术后并发症等资料。结果 45例均顺利完成手术。改良组18例，无一例死亡；传统组27例，其中1例因感染性休克并发多器官功能衰竭死亡；改良组术后并发症发生率低于传统组，差异有统计学意义（P<0.05）。改良组手术时间为（89.50±16.73）min，传统组手术时间为（86.07±17.27）min，差异无统计学意义（P>0.05）。改良组术后无一例并发症，传统组术后14例出现并发症，差异有统计学意义（P<0.05）。改良组术后住院时间为（19.89±4.54）d，传统组术后住院时间为（24.73±11.57）d，差异有统计学意义（P<0.05）。改良组非计划再次手术1例，传统组非计划再次手术10例，差异有统计学意义（P<0.05）。结论 改良式肠造口引流装置应用于新生儿肠造瘘手术可有效降低肠造瘘术后的并发症发生率，并且具有操作简单、术后外形美观、护理方便等优点，值得临床推广应用。
- Abstract:
- Objective To explore the safety and value of improved enterostomic drainage device in the treatment of neonatal intestinal fistula.Methods A retrospective analysis was performed for 45 hospitalized cases of neonatal intestinal fistula undergoing emergency or sub-emergency laparotomy from 2011 to 2018.Intestinal fistula surgery was divided into conventional group (n=27) and modified group (n=18) by parallel control and randomized allocation.The general clinical data of two groups were compared.The difference was not statistically significant (P>0.05).The modified group underwent circumcision and contraception at the proximal end of fistula.And an intestinal fistula drainage device was applied.The surgical outcome,intraoperative blood loss,number of unplanned reoperations,operative duration,postoperative hospital stay and postoperative complications were compared between two groups.Results All operations were successful.In improved group,all cases were cured; in traditional group,there was one case of mortality of septic shock due to multiple organ failure.The postoperative complications of modified group were lower than those of traditional group.And the difference was statistically significant (P<0.05).The operative duration of modified group was (89.50±16.73) min and that of traditional group (86.07±17.27) min.And the difference was not statistically significant (P>0.05).No complications occurred in modified group while 14 cases had complications in conventional group.And the difference was statistically significant (P<0.05).The number of hospital stays was (19.89±4.54) days in modified group and (24.73±11.57) days in conventional group.And the difference was statistically significant (P<0.05).One patient in modified group was re-operated while 10 patients in traditional group underwent another operation.And the difference was statistically significant (P<0.05).Conclusion Clinical application of modified stoma drainage device for neonatal intestinal fistula can effectively reduce the incidence of postoperative complications.With the advantages of simpler handling,pleasant appearance and convenient postoperative care,it is worthy of wider popularization.
参考文献/References:
1 Bishop HC.Colostomy in the newborn:Indications,techniques,complications and care[J].Am J Surg,1961,101(5):642-648.DOI:10.1016/0002-9610(61)90275-6.
2 Cain WS,Kiesewetter WB.Infant colostomy:Its role and complications[J].Arch Surg,1965,91(2):314-320.DOI:10.1097/00000658-196506000-00017.
3 刘玉献,徐步存.包皮环扎术与包皮环切术治疗小儿包茎、包皮过长疗效分析[J].河南外科学杂志,2013,19(3):103-104.DOI:10.3969/j.issn.1007-8991.2013.03.083. Liu YX,Xu BC.Efficacy analysis of prepuce cerclage and circumcision for pediatric phimosis and redundant prepuce[J].Henan Journal of Surgery,2013,19(3):103-104.DOI:10.3969/j.issn.1007-8991.2013.03.083.
4 彭友林,韩武红.包皮环扎与包皮环切两种术式的比较[J].中国男科学杂志,2010,24(6):62-63.DOI:10.3969/j.issn.1008-0848.2010.06.018. Peng YL,Han WH.Comparison of prepuce cerclage versus circumcision[J].Chinese Journal of Andrology,2010,24(6):62-63.DOI:10.3969/j.issn.1008-0848.2010.06.018.
5 李仁举,田金徽,杨克虎,等.包皮环套术治疗小儿及青少年包茎或包皮过长的Meta分析[J].循证医学,2010,10(2):92-97.DOI:10.3969/j.issn.1671-5144.2010.02.009. Li RJ,Tian JH,Yang KH,et al.Circumcision in the treatment of toddler and adolescent phimosis and redundant prepuce:a Meta-analysis[J].Journal of Evidence-based Medicine,2010,10(2):92-97.DOI:10.3969/j.issn.1671-5144.2010.02.009.
6 Ohashi K,Koshinaga T,Uehara S,et al.Sutureless enterostomy for extremely low birth weight infants[J].J Pediatr Surg,2017,52(11):1873-1877.DOI:10.1016/j.jpedsurg.2017.08.009.
7 Steinau G,Ruhl KM,H?rnchen H,et al.Enterostomy complications in infancy and childhood[J].Langenbecks Arch Surg,2001,386(5):346-349.DOI:10.1007/s 004230100243.
8 唐维兵,徐小群,耿其明,等.新生儿结肠造瘘术165例分析[J].临床小儿外科杂志,2008,7(5):41-43.DOI:10.3969/j.issn.1671-6353.2008.05.014. Tang WB,Xu XQ,Geng QM,et al.Neonatal colostomy:a report of 165 cases[J].J C Ped Sur,2008,7(5):41-43.DOI:10.3969/j.issn.1671-6353.2008.05.014.
9 Edwards DP,Leppington-Clarke A,Sexton R,et al.Stoma-related complications are more frequent after transverse colostomy than loop ileostomy:a prospective randomized clinical trial[J].Br J Surg,2001,88(3):360-363.DOI:10.1046/j.1365-2168.2002.208816.x.
10 林海,李权,林国雄.预置切口缝线预防小儿肠造瘘关瘘术后切口感染[J].临床小儿外科杂志,2011,10(5):392-393.DOI:10.3969/j.issn.1671-6353.2011.05.26. Lin H,Li Q,Lin GX.Incision pre-suturing in the prevention of postoperative stoma infections after pediatric enterostomy[J].J Clin Ped Sur,2011,10(5):392-393.DOI:10.3969/j.issn.1671-6353.2011.05.26.
11 Musemeche CA,Kosloske AM,Ricketts RR.Enterostomy in necrotizing enterocolitis:an analysis of techniques and timing of closure[J].J Pediatr Surg,1987,22(6):479-483.DOI:10.1016/S0022-3468(87)80200-2.
12 Nour S,Beck J,Stringer MD.Colostomy complications in infants and children[J].Ann R Coll Surg Engl,1996,78(6):526-530.DOI:10.1007/BF02306098.
13 Chandramouli B,Srinivasan K,Jagdish S,et al.Morbidity and mortality of colostomy and its closure in children[J].J Pediatr surg,2004,39(4):596-599.DOI:10.1016/j.jpedsurg.2003.12.016.
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备注/Memo
收稿日期:2018-12-29。
基金项目:东莞市社会科技发展一般项目（编号：2018507150071531）
通讯作者:伍岗泉,Email:mmwgq71@126.com