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J Zhejiang Univ (Med Sci)  2018, Vol. 47 Issue (3): 255-260    DOI: 10.3785/j.issn.1008-9292.2018.06.06
    
Experience in treatment of complex congenital intestinal atresia in children
ZHANG Shisong(),WU Yurui*(),LIU Hongzhen,ZHAI Yunpeng,LIU Wei
Department of Thoracic and Oncological Surgery, Qilu Children's Hospital of Shandong University, Jinan 250022, China
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Abstract  

Objective: To summarize experience in the treatment of complex congenital intestinal atresia in children, so as to investigate the key points and effect of the operation. Methods: Medical notes of 49 children with complex intestinal atresia treated between January 2012 and January 2018 were reviewed. The information of age, sex, age at operation, full-term or premature, birth weight, clinical manifestation, auxiliary examination, preliminary diagnosis, treatment process, discharge diagnosis, pathological results and prognosis of patients were analyzed. Results: All patients underwent surgical treatment, including 42 cases with laparotomy (85.7%) and 7 with laparoscopic surgery (14.3%); 1 case undergoing laparoscopic surgery was converted to laparotomy due to meconium peritonitis. The mean operation time was (147±43) min (70-270 min); the mean fasting time after surgery was (8±3) d (4-16 d); the mean parenteral nutrition time was (12±6) d (3-30 d). Eleven cases were discharged against medical after operation and lost to follow-up. Among rest 38 children, 1 child (2.6%) received intestinal resection and ostomy five days after operation due to gastrointestinal perforation; 1 child (2.6%) received conservative treatment one month later due to adhered intestinal obstruction and left hospital with cure; 1 child (2.6%) received enterodialysis and ileostomy eight days after operation due to anastomotic leak, and received the operation for the closure of fistula after three months; 4 children had complications including fluid and electrolyte disorders, anemia, hypoproteinemia and so on, and recovered after conservative treatments. Postoperative follow-up showed that 1 child with duodenal atresia had lower body weight at 6 month after operation, but the body weight returned to normal when the child was one year old; 1 child with preterm labor of 32 weeks was treated with enteral nutrition, and gradually restored the normal diet after 6 months. Growth retardation was not observed in other children. Conclusion: With active treatment and reservation of normal bowel tube as much as possible during the operation, the prognosis of children with complex intestinal atresia is usually favorable.



Key wordsIntestinal atresia/surgery      Anastomosis, surgical/methods      Enema      Fasting      Parenteral nutrition      Treatment outcome     
Received: 23 March 2018      Published: 18 September 2018
CLC:  R628  
  R726.2  
Corresponding Authors: WU Yurui     E-mail: zsli323@163.com;wuyrr@163.com
Cite this article:

ZHANG Shisong,WU Yurui,LIU Hongzhen,ZHAI Yunpeng,LIU Wei. Experience in treatment of complex congenital intestinal atresia in children. J Zhejiang Univ (Med Sci), 2018, 47(3): 255-260.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2018.06.06     OR     http://www.zjujournals.com/med/Y2018/V47/I3/255


复杂型先天性肠闭锁患儿治疗体会

目的: 总结复杂型先天性肠闭锁的治疗经验,探讨其治疗要点及手术效果。方法: 回顾性分析2012年1月至2018年1月山东大学齐鲁儿童医院收治的49例复杂型肠闭锁患儿的临床资料,收集患儿的年龄、性别、手术日龄、是否足月、出生体质量、临床表现、辅助检查、初步诊断、治疗过程、出院诊断、病理结果、预后等信息,并进行分析。结果: 所有患儿均行手术治疗,其中传统开腹手术治疗42例(85.7%),腹腔镜手术治疗7例(14.3%,1例因合并胎粪性腹膜炎中转开腹手术)。所有患儿手术时间为70~270 min,平均(147±43)min;术后禁食时间为4~16 d,平均(8±3)d;肠外营养时间为3~30 d,平均(12±6)d。11例患儿术后自动出院并失访。其余38例患儿中,1例(2.6%)因消化道穿孔于术后第5天行肠切除吻合术;1例(2.6%)于术后1个月因粘连性肠梗阻再次入院并行保守治疗;1例(2.6%)于术后第8天因吻合口瘘行肠粘连松解和回肠造瘘术,3个月后行二期闭瘘术;4例患儿术后分别出现水、电解质紊乱,低蛋白血症,高胆红素血症等并发症,均保守治疗后好转。术后随访期间,1例十二指肠闭锁患儿术后6个月较同龄健康儿童体质量低2个标准差,至1岁时体质量达到同龄健康儿童水平;1例32周早产患儿术后行肠内营养治疗,6个月后逐渐恢复正常饮食;其他患儿均无明显生长发育迟缓。结论: 复杂型肠闭锁患儿经积极治疗,术中尽可能保留正常肠管,预后大多良好。


关键词: 肠闭锁/外科学,  吻合术, 外科/方法,  灌肠,  禁食,  胃肠外营养,  治疗结果 
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