横结肠袢式造口术在先天性肛门直肠畸形分期手术中应用的临床研究

发布时间：2018-05-13 14:14

  本文选题：横结肠袢式造口术 + 先天性肛门直肠畸形　； 参考：《第三军医大学学报》2017年18期

【摘要】：目的探讨并总结横结肠袢式造口术在先天性肛门直肠畸形患儿分期治疗中的优缺点。方法回顾性分析62例先天性肛门直肠畸形患儿行预防性横结肠袢式造瘘术后的临床表现及相关重要辅助检查;综合分析该造口手术对先天性肛门直肠畸形患儿整个治疗过程的影响,并分析原因。结果 (1)62例患儿二期和三期术前血常规结果显示分别有21例(33.9%)vs 22例(35.5%)发生轻度贫血;无重度及极重度贫血发生。(2)62例患儿二期和三期术前分别有5例(8.1%)vs 1例(1.6%)出现轻度低蛋白血症。(3)62例患儿二期术前外周血电解质检查显示,7例(11.3%)出现轻度电解质紊乱,其中6例在三期术前完全恢复,无高氯血症发生。(4)62例患儿尿常规结果显示,二期和三期术前分别有19例(30.7%)vs 4例(6.4%)尿液白细胞数目异常,数目为(124.42±106.33)vs(74.75±52.89)个/μL,仅有1例出现明显尿路感染症状。(5)57例患儿在二期术前经横结肠造口行远端造影均能明确异常瘘管位置,与术中发现完全一致(100%),并将造影测得直肠盲端与肛隐窝间距离(34.63±6.01)mm,与术中实际测得距离(37.33±6.17)mm比较,差异无统计学意义(t=0.066,P0.05)。(6)62例患儿造口随访观察结果显示无严重肠管回缩及脱垂。结论横结肠袢式造口术应用于先天性肛门直肠畸形患儿分期治疗,具有操作简单,并发症少,且对患儿营养状况及生长发育无严重不良影响。
[Abstract]:Objective to investigate and summarize the advantages and disadvantages of transverse colon loop ostomy in the treatment of congenital anorectal malformation. Methods 62 cases of congenital anorectal malformation were analyzed retrospectively. The effect of the operation on the whole treatment of congenital anorectal malformation was analyzed and the causes were analyzed. Results the results of preoperative blood examination showed that 21 cases (33.9% vs 22 cases) developed mild anemia. In 62 children with no severe or extremely severe anemia, there were 5 cases with mild hypoproteinemia and 1 case with mild hypoproteinemia before the second and third stages, respectively. The peripheral blood electrolyte examination showed that 7 cases (11. 3%) had mild electrolyte disorder before the second stage operation, and 5 cases (8. 1% vs 1. 6%) had mild electrolyte disorder before the second stage operation, and the results showed that 7 cases (11. 3%) had mild electrolyte disorder. Among them, 6 cases recovered completely before stage 3 and 62 cases did not have hyperchloremia. The results of urine routine showed that there were 19 cases (30.7% vs 4 cases) with abnormal white blood cell count in urine before the second and third stages, respectively. The number of cases was 124.42 卤106.33)vs(74.75 卤52.89 / 渭 L, and only one case showed obvious urinary tract infection. All the 57 cases underwent distal radiography through transverse colostomy before the second stage of operation were able to identify the location of anomalous fistula. The distance between rectum cecum and anal rectum was 34.63 卤6.01 mm and 37.33 卤6.17)mm, respectively. There was no significant difference between rectal rectum and rectum. There was no significant difference in the length of rectum between rectum and anal rectum. There was no serious intestinal rectum retraction or prolapse. Conclusion the transverse colon loop ostomy has simple operation, few complications and no serious adverse effects on nutritional status, growth and development of children with congenital anorectal malformation.
【作者单位】： 重庆医科大学附属儿童医院胃肠新生儿外科儿童发育疾病研究教育部重点实验室儿科学重庆市重点实验室 重庆市儿童发育重大疾病诊治与预防国际科技合作基地;
【基金】：国家临床重点专科建设项目(国卫办医函[2013]544) 重庆市卫计委医学科研重点项目(20141010)~~
【分类号】：R726.5
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本文编号：1883515