目的 探讨B超引导下食管闭锁术后食管吻合口瘘患儿置入空肠营养管的临床实用性和安全性。 方法 对15例食管闭锁术后食管吻合口瘘的婴幼儿,在B超导引下放置空肠营养管。经床边X造影定位后行肠内营养,观察插管过程,营养管开口位置,置管后并发症。 结果 15例患儿均一次性置管成功,经X线摄片定位,12例导管开口端位于空肠起始部,3例导管开口端位于十二指肠降部; 置管时间最长30 min,最短8 min,平均置管时间10±5 min。2例患儿置管时间达30 min,12 h内出现胃部不适,呕吐淡咖啡色液体约5～10 mL; 留置时间最长90 d,最短7 d; 非计划性拔管6例。 结论 食管闭锁术后吻合口瘘在B超导引下放置空肠营养管是一项安全的,费用低廉,成功率高的操作。
Objective To explore the clinical practicability and safety of inserting jejunal nutrition tube with ultrasonic guidance for postoperative esophageal anastomotic fistula in children with esophageal atresia(EA). Methods For 15 EA infants with postoperative esophageal anastomotic fistula, jejunal nutrition tube was inserted under ultrasonic guidance. By bedside radiological imaging, tube positioning was confirmed and the intubation process observed. Results All insertions were successful. Open ends were located in starting jejunum(n=12)and desending duodenum(n=3). The mean duration of catheterization was 10±5(8-30)min. At 12h, there was an onset of upset stomach and vomiting with a volume of pale brown liquid 5-10 ml. The indwelling duration was up to 90 days and the shortest 1 week. Six cases had unscheduled decannulation. Conclusion Inserting jejunal nutrition tube with ultrasonic guidance for postoperative esophageal anastomotic fistula is both safe and affordable with a high success rate.
