Huang Hua,Ma Shuaijun,Ma Xiaoyu,et al.Preliminary experience with Kareem procedure in the surgical correction of pediatric intestinal malrotation[J].Journal of Clinical Pediatric Surgery,2025,(08):771-775.[doi:10.3760/cma.j.cn101785-202501008-012]
Kareem手术矫治小儿肠旋转不良
- Title:
- Preliminary experience with Kareem procedure in the surgical correction of pediatric intestinal malrotation
- Keywords:
- Gastrointestinal Tract; Digestive System Malformations; Intestinal Volvulus; Surgical Procedures; Operative; Child
- 摘要:
- 目的 初步探讨Kareem手术矫治小儿肠旋转不良的可行性及安全性。方法 回顾性分析郑州大学第三附属医院新生儿外科2024年1月至2024年11月收治的13例肠旋转不良患儿临床资料。患儿均行Kareem手术治疗。收集患儿一般资料、手术时间、术后疗效及随访情况。结果 13例患儿中,11例因呕吐入院,2例因血便入院;年龄1日龄至10岁;男10例,女3例;5例经术前胃肠超声检查提示肠扭转确诊,8例经术中探查诊断为肠旋转不良。术中5例合并肠扭转,2例合并绞窄性肠梗阻,1例合并先天性小肠闭锁,1例合并先天性膈疝。手术时间(119.46±24.93)min,术后开奶时间6.00(4.50,6.50)d,住院时间(23.00±8.81)d。术后10例喂养顺利,均无呕吐、无再发肠扭转;2例发生粘连性肠梗阻(1例接受保守治疗,1例接受手术治疗),均治愈出院;1例逐渐增加喂养量后出现间断呕吐,经保守治疗未见好转,术中病理检查提示肠神经节细胞发育不良,转外院手术行回肠造口后呕吐好转。结论 Kareem手术矫治小儿肠旋转不良,通过使肠-肠系膜结构和血管解剖恢复到正常生理位置,从而避免或减少再发肠扭转,术后短期疗效满意,具有一定的可行性和安全性,可作为矫治小儿肠旋转不良的一种新的术式选择,但远期疗效仍需进一步扩增样本量、开展多中心研究进行随访。
- Abstract:
- Objective To preliminarily explore the feasibility and safety of the Kareem procedure in correcting intestinal malrotation in children. Methods A retrospective analysis was conducted on clinical data of 13 pediatric patients with intestinal malrotation treated with the Kareem procedure in the Department of Neonatal Surgery at the Third Affiliated Hospital of Zhengzhou University from January to November 2024.Data collected included general patient information,operative time,postoperative recovery,and follow-up outcomes. Results Among the 13 patients,11 were admitted due to vomiting and 2 due to hematochezia; ages ranged from 1 day to 10 years; 10 were male and 3 female.5 cases were diagnosed preoperatively via gastrointestinal ultrasound suggesting volvulus,while 8 were diagnosed intraoperatively as intestinal malrotation.Intraoperatively,5 patients had concurrent volvulus,2 had strangulated intestinal obstruction,1 had congenital small intestinal atresia,and 1 had congenital diaphragmatic hernia.The mean operative time was 119.46±24.93 minutes; time to initiate feeding postoperatively was 6.00 (4.50,6.50) days; and mean hospital stay was 23.00 ±8.81 days.10 patients tolerated feeding well postoperatively with no vomiting or recurrence of volvulus.2 developed adhesive intestinal obstruction,1 managed conservatively and 1 surgically,with both recovering and being discharged.One patient experienced intermittent vomiting after gradual feeding advancement; conservative treatment was ineffective.Pathology revealed intestinal neuronal dysplasia,and the patient underwent ileostomy at another hospital,with improvement in vomiting. Conclusions The Kareem procedure for pediatric intestinal malrotation restores the intestino-mesenteric anatomy and vascular structures to their normal physiological positions,helping prevent or reduce recurrent volvulus.The short-term outcomes are satisfactory,suggesting the procedure is feasible and safe.It may serve as a new surgical option for pediatric intestinal malrotation,though further large-scale and multicenter studies are needed to evaluate long-term efficacy.
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备注/Memo
收稿日期:2025-1-5。
通讯作者:黄华,Email:hhuang0989@163.com