Cao Jianying,Liu Gang,Han Jinbao,et al.Mesenteric fixation and preserved bowel for high jejunal atresia with type Ⅲb intestinal atresia[J].Journal of Clinical Pediatric Surgery,2023,22(09):827-831.[doi:10.3760/cma.j.cn101785-202303062-006]
高位空肠Ⅲb型肠闭锁远端肠管保留和系膜固定的可行性探讨
- Title:
- Mesenteric fixation and preserved bowel for high jejunal atresia with type Ⅲb intestinal atresia
- Keywords:
- Intestinal Atresia; Surgical Procedures; Operative; Child; Therapy
- 摘要:
- 目的 初步探讨肠系膜固定联合端侧吻合术治疗高位空肠Ⅲb型肠闭锁伴长段型苹果皮样肠管患儿的可行性。方法 回顾性分析2017年10月至2022年1月解放军总医院第七医学中心收治的7例高位空肠Ⅲb型肠闭锁伴长段型或全肠型苹果皮样肠管患儿临床资料,总结上述患儿的手术方式、治疗经过及出院后随访相关资料。结果 7例患儿中,2例为全肠型苹果皮样闭锁,5例为全小肠苹果皮样闭锁;7例均采取将远端系膜缺损苹果皮样肠管固定于近端扩张的空肠,切除多余小肠后与近端扩张肠管行端侧吻合术,并经鼻放置空肠营养管。1例患儿于术后第3天死亡;存活6例,术后3~5 d采取经空肠营养管泵奶的方式喂养,奶量达全肠内营养后逐渐过渡至口服喂养。出院后对存活的6例患儿随访1~5年,无一例出现肠梗阻、营养不良、慢性腹泻等术后并发症,均达到同龄健康儿童的标准身高和体重。结论 对于高位空肠Ⅲb型肠闭锁伴长段苹果皮样肠管患儿,围绕闭锁盲端的肠系膜固定是可以安全保留较多苹果皮样肠管的较优选择。
- Abstract:
- Objective To explore the feasibility of mesenteriopexy with end-to-side anastomosis for high jejunal atresia with type Ⅲb intestinal atresia with long-segment or whole intestinal apple-peel appearance.Methods From October 2017 to January 2022,retrospective analysis was performed for 7 children of high jejunal atresia with type Ⅲb intestinal atresia with long-segment or whole intestinal apple-peel appearance.The follow-up outcomes were summarized.Results Among them,there were enterocolon apple-peel atresia (n=2) and whole intestinal apple-peel atresia (n=5).Distal mesangial defect was fixed to dilated proximal jejunum.End-to-side anastomosis was performed after pruning occluded distal bowel and dilated proximal bowel.A jejunal nutrition tube was placed.Except for one death,the remainders survived.At Day 3-5 post-operation,enteral nutrition was pumped through a jejunal nutrition tube.Oral feeding resumed gradually after total enteral nutrition.During a follow-up period of (1-5) years,there were no such postoperative complications as intestinal obstruction,malnutrition or chronic diarrhea.All of them reached the standard height and weight of children of the same age.Conclusion For high jejunal atresia with type Ⅲb intestinal atresia with long-segment apple-peel bowel long-segment apple-peel high jejunal atresia in children,mesenteriopexy around blind-end is indicated for tube preservation.
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备注/Memo
收稿日期:2023-3-28。
基金项目:军队计生专项(21JSZ18)
通讯作者:黄柳明,Email:surhlm@126.com