摘要:
目的 探讨对于极限短距离末端回肠单孔造瘘患儿二期行保留回盲瓣的末端回肠吻合术的可行性.方法 回顾性分析解放军总医院第七医学中心八一儿童医院儿童基础外科2014年至2017年收治的11例因各种消化道疾病导致极限短距离末端回肠单孔造瘘的患儿(极限短距离指远端末端回肠距离回盲瓣小于0.5 cm),二期进行保留回盲瓣的末端回肠吻合术.其中男7例,女4例;8例新生儿坏死性小肠结肠炎(其中2例剩余小肠<60 cm),3例回盲部肠闭锁(其中1例盲端在回盲部扭转坏死).所有患儿均一期行末端回肠单孔造瘘手术.关瘘手术月龄平均为6个月,范围3~8个月;体重平均为5.4kg,范围2.3~6.5kg.吻合术前小肠的剩余长度平均为90cm,范围为50~140 cm,其中2例剩余长度<60 cm;远端回肠吻合口与回盲瓣的距离范围为0~0.5 cm.术后监测指标包括术后肠功能恢复、营养以及是否出现吻合口漏、吻合口狭窄、肠梗阻等并发症情况.结果 所有患儿在极限短距离条件下顺利完成保留回盲瓣的末端回肠吻合术,术后无吻合口漏、吻合口狭窄等并发症出现.其中3例因回盲瓣闭锁或狭窄,需先行回盲瓣成形术,方可进行末端回肠端端吻合术;7例患儿术后恢复顺利,4例因出现感染导致住院时间延长,恢复延迟(其中3例出现伤口感染,1例出现院内感染导致脓毒血症和感染性休克).随访时间为5~36个月,所有患儿均没有出现肠梗阻症状、营养不良、长期腹泻等术后并发症,身高和体重均达到正常同龄儿水平.结论 对于极限短距离末端回肠单孔造瘘术后的婴幼儿,二期行保留回盲瓣的末端回肠吻合术是安全可行的.%Objective To explore the feasibility of ileocecal valve-preservation ileocecostomy (IVPI) for infants with an extremely short distal ileal stump after primary single side ileostoma . Methods A retrospective analysis was performed for 11 IVPI cases from 2014 to 2017 .There were 7 boys and 4 girls .The causes were neonatal necrotizing enterocolitis (NEC) (n=8 ,length of residual small intestine <60 cm in 2) and ileocecal atresia (n= 3 ,torsional necrosis of blind end in 1) .All children underwent primary distal single side ileostoma .The average operative closure age was 6 (3-8) months ,the average body weight 5 .4 (2 .3-6 .5) kg and the average pre-anastomotic residual length of small intestine 90 (50-140) cm .Among them ,the residual length was < 60 cm in two cases .The distance from distal ileal stoma to ileocecal valve had a range of 0-0 .5 cm .The relevant clinical data included age ,weight ,length of ileal stump ,surgical technique ,complications and short/medium-term follow-ups .Results IVPI was successfully performed in all patients without anastomotic leakage or stenosis .Ileocecal valve plasty was performed due to ileocecal valve atresia or stenosis (n=3) .Seven cases were uneventful postoperatively whereas wound infection (n= 3) and acquired sepsis (n= 1) caused a delayed recovery .During a follow-up period of 5-36 months ,there was no onset of bowel obstruction ,malnutrition ,chronic diarrhea or other late complications .Body height and weight were all normal .Conclusions IVPI is both safe and feasible for infants with an extremely short distal ileal stump .