Chen Faling,Xu Weijue,Huang Xiong,et al.Experience of treatment of intestinal stenosis after one-stage intestinal resectional anastomosis for neonatal necrotizing enterocolitis[J].Journal of Clinical Pediatric Surgery,2020,19(11):1016-1020.[doi:10.3969/j.issn.1671-6353.2020.11.011]
一期肠切除肠吻合术治疗新生儿坏死性小肠结肠炎后肠狭窄
- Title:
- Experience of treatment of intestinal stenosis after one-stage intestinal resectional anastomosis for neonatal necrotizing enterocolitis
- Keywords:
- Enterocolitis; Necrotizing; Gastroenterostomy; Infant; Newborn
- 分类号:
- R722.1;R574.62
- 摘要:
- 目的 总结一期肠切除肠吻合术治疗新生儿坏死性小肠结肠炎（necrotizing enterocolitis，NEC）后肠狭窄的经验。方法 回顾性分析2012年6月至2019年6月上海市儿童医院普外科行一期肠切除肠吻合术治疗的18例NEC后肠狭窄患儿临床资料（包括确诊NEC后至肠狭窄的时间、手术年龄、狭窄部位、术后并发症等）并进行经验总结。结果 18例确诊NEC后至肠狭窄的平均时间为45.7天；手术时平均日龄73.8天。狭窄部位仅1处者14例：7例位于回肠末端，5例位于升结肠，2例位于降结肠；多发狭窄者4例，其中1例位于回盲部和降结肠乙状结肠交界部，1例位于回肠末端和降结肠乙状结肠交界部，1例位于升结肠和横结肠中段，1例位于结肠肝曲和脾曲。5例出现术后并发症，其中4例再次行肠造瘘术，原因分别为：2例吻合口漏、1例吻合口狭窄、1例吻合口近端肠粘连扭转坏死；另1例再发回盲部狭窄，再行肠切除肠吻合术。18例均获随访，预后良好，4例肠造瘘者已关瘘3例，无其他并发症。结论 一期肠切除肠吻合术治疗NEC后肠狭窄效果整体良好，狭窄常发于末端回肠和升结肠。诊断需综合临床表现及消化道造影结果，术中需对可疑肠管注水充盈以排除多发狭窄。NEC后肠狭窄有一定的发病形成时间，需把握一期手术时机并保证剩余肠管质量，避免发生术后再发狭窄或其他并发症。
- Abstract:
- Objective To summarize the treatment of intestinal stenosis after one-stage intestinal resectional anastomosis for neonatal necrotizing enterocolitis (NEC).Methods Clinical data were retrospectively reviewed for 18 NEC children with stenosis after one-stage intestinal resectional anastomosis from June 2012 to June 2019.The relevant data included time from a diagnosis of NEC to intestinal stenosis,operative age,location of stenosis and postoperative complications.Results The average time from a diagnosis of NEC to intestinal stenosis was 45.7 days and the average operative age 73.8 days.The locations were terminal ileum (n=7),ascending colon (n=5) and descending colon (n=2).And multiple stenoses were found at ileocecal & hypoglycemic junctions (n=1),terminal ileum & hypoglycemic junction (n=1),ascending & middle transverse colons (n=1) and colonic hepatic & spleen curvatures (n=1).The causes of complications were anastomotic leak (n=3),anastomotic stenosis (n=1) and anastomotic proximal intestinal adhesion (n=1).And 4/5 complicated cases underwent intestinal re-ostomy.Three cases of intestinal ostomy achieved closure and had no other complications.During follow-ups,the prognosis was decent.Conclusion One-stage intestinal resectional anastomosis is generally effective for intestinal stenosis after NEC.Stenosis occurs frequently in terminal ileum and ascending colon.A definite diagnosis is based upon clinical manifestations and gastrointestinal angiography.Suspicious bowel is filled with water intraoperatively for excluding multiple stenoses.NEC has a certain onset time for intestinal stenosis.It is necessary to grasp the timing of one-stage surgery and ensure the quality of remaining intestinal tract to avoid postoperative recurrence of stenosis.
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备注/Memo
收稿日期:2019-11-20。
基金项目:上海市浦江人才计划资助（编号：19PJ1409000）；上海市儿童医院临床研究培育专项重点项目（编号：2019YLYZ03）
通讯作者:徐伟珏,Email:fafa84074138@126.com