新生儿坏死性小肠结肠炎经回肠造瘘术后远端肠闭锁7例

摘要

Objetive To explore the clinical features and treatment experiences of children with ac-quired intestinal atresia after ileostomy due to necrotizing enterocolitis (NEC). Methods The clinical data were retrospectively analyzed for 7 surgical cases with acquired intestinal atresia after ileostomy.The primary cause was necrotizing enterocolitis.There were no obvious symptoms.Gastrointestinal contrast study revealed colonic obstruction before closure of ileostomy.Atresia was present in ileum and colon.Two patients had multi-ple atresia.Results All patients were cured surgically.One case had intermittent hematochezia at 3 months after surgery and gastrointestinal contrast study indicated stenosis of anastomotic stoma.No other symptoms oc-curred during follow-ups. Conclusions Stricture develops easily in patients after NEC.Acquired intestinal atresia after ileostomy should be kept in mind.Inflammation may be one of main reasons.%目的：探讨新生儿坏死性小肠结肠炎（NEC）行回肠造瘘术后，造瘘远端肠闭锁的临床特点和诊治经验。方法对本院自2010年7月至2015年2月收治的7例 NEC 行回肠造瘘术后，远端继发肠闭锁的临床资料进行回顾性分析。7例均无明显临床表现，结肠造影提示结肠梗阻。术中发现闭锁部位：2例为两处闭锁，1例为回肠末端、结肠肝区闭锁，1例为结肠脾区、乙状结肠闭锁；其余5例为单处闭锁，3例为乙状结肠闭锁，1例为降结肠闭锁，1例为横结肠闭锁。结果7例手术后均痊愈出院，7例随访过程中，1例间断出现肉眼或镜下血便，经结肠造影发现有结肠狭窄，其余无明显排便异常表现，疗效满意。结论临床上 NEC 保守治疗后反复喂养不耐受、腹胀，应警惕肠狭窄；行回肠造瘘术后，远端肠管发生继发性闭锁应予以重视，炎症反应可能是其主要原因之一。一期造瘘术后应定期对远端肠管给予盐水灌肠，以避免肠管炎性闭锁发生。