经阑尾残端置管造瘘在小儿一期末段回肠切除术中的应用研究

福建省福州儿童医院普外科(福建省福州市,350000),Email:2042105667@qq.com

末段回肠; 吻合口漏; 回盲瓣; 阑尾造瘘; 儿童

Application of indwelling catheter through appendix stump fistula in one-stage terminal ileectomy.
Huang Shengyu,Xie Cheng,Lin Lihua,Fu Junjie,Zhang Tongfu.

Department of General Surgery,Fuzhou Children's Hospital of Fujian Province,Fujian Medical University Affiliated Children's Hospital,Fuzhou 350000,China

Terminal ileum; Stomal leak; ileocecal valve; Appendix stump fistula; Child

DOI: 10.3969/j.issn.1671— 6353.2018.04.008

备注

目的 探讨经阑尾残端置管造瘘在小儿一期末段回肠切除术中应用的安全性与实用价值。方法 2007年1月至2016年12月,本院收治38例不同病因引起的末段回肠病变患儿,均采用急诊或亚急诊剖腹探查术,术中均行一期末段病变回肠切除吻合术,吻合口距离回盲瓣10 cm以内,同时经阑尾切除的残端置入硅胶管至吻合口近端行回肠造瘘术。结果 所有病例手术顺利,除末段回肠闭锁与胎粪性肠梗阻伴末段回肠狭窄的患儿于术后8 d及6 d肛门及造瘘管排气、排便以外,其余病例均于术后3~4 d肠功能恢复,全部病例于肛门排气排便第2天拔除胃管予流质饮食,1~2 d后无腹胀及呕吐,予半流质饮食,术后4~5 d右髂窝引流管未见明显液体引出并经超声检查腹腔无积液后予拔除引流管,7~14 d腹部探查切口拆线愈合良好,带造瘘管出院,平均住院时间9 d。出院后2~5 d患儿饮食及大小便正常,造瘘管无明显粪便排出,在门诊拔除造瘘管,2~3 d后瘘口自行愈合。门诊随访6个月至2年,未见吻合口瘘、吻合口狭窄、腹膜炎、肠粘连及肠扭转等并发症。结论 小儿末段病变回肠切除一期回肠吻合术,吻合口距离回盲瓣10 cm以内,辅以经阑尾残端置硅胶管至吻合口近端行回肠造瘘术,能有效避免吻合口漏等致命性并发症的发生,且保留了回盲瓣的生理功能,对患儿消化吸收及生长发育无影响,值得临床推广应用。
Objective To explore the safety and practicality of applying indwelling catheter through appendix stump fistula in one-stage terminal ileectomy. Methods Retrospective analyses were conducted for 38 children hospitalized with terminal ileum diseases from January 2007 to December 2016.After emergency or sub-emergency laparotomy,one-stage terminal ileum excision and anastomosis were performed.And anastomotic stoma was less than 10 cm away from ileocecus.And indwelling silica gel tube was guided through appendix stump fistula into proximal anastomosis. Results All operations were successful.The cases of terminal ileum atresia or terminal ileum stenosis in meconium ileus had anus exhaust at Days 8 and 6.In other cases,postoperative bowel function recovered at Days 3-4.All of them defecated after removing gastric tube and resumed a liquid diet after anus exhaust.And had semi-liquid diet without abdominal distention and vomiting after 1-2 days.After no ultrasonic evidence of liquid or seroperitoneum,drainage tube in right iliac fossa elicit was removed at Days 4-5.The incisions healed well at Days 7-14.The average duration of hospitalization was 9 days.Both diet and urine were normal without defecation in fistula at Days 2-5 after discharge.And fistula self-healed at Days 2-3.During outpatient follow-ups for 6 months to 2 years,there was no occurrence of such complications as anastomotic fistula,anastomotic stricture,peritonitis,intestinal adhesion or volvulus. Conclusion One-stage terminal ileum excision and anastomosis are successful.It can effectively avoid anastomotic leak and retain physiological function of ileocecus.Yet it has no effect upon the growth,digestion and absorption of children.It's worthy of wider clinical application.