新生儿肛门直肠畸形并发穿孔临床分析

发布时间：2018-10-18 17:00

【摘要】：目的 :探讨新生儿肛门直肠畸形并发穿孔的临床特点、手术方式和预后,以期为合理的临床诊疗提供资料。方法 :选择2006年1月—2016年12月南京医科大学附属儿童医院收治的新生儿肛门直肠畸形并发穿孔患儿11例,回顾性分析其临床资料,总结发病特征、诊治经过及转归。结果:本组中7例低位畸形,4例中高位畸形;男10例,女1例;男女间低位和中高位发病差异无统计学意义。入院时伴发感染性休克3例的就诊年龄均48 h。发病时均主要表现为腹胀并呈进行性加重,其中3例会阴肛门成形术后或结肠造口术后突发腹胀,4例有胆汁或粪汁样呕吐,10例腹部立位平片见膈下游离气体。3例放弃手术后自动出院。手术治疗的8例中直肠穿孔5例,结肠穿孔3例,手术均予彻底切除病变组织后行穿孔近端肠造口。3例于肠造口术后1 d内自动出院,余5例根治术后除2例高位畸形排便功能不佳外,无其他消化道不适症状。结论:新生儿肛门直肠畸形并发穿孔以进行性加重的腹胀或伴胆汁性粪汁性呕吐为表现,有气腹可明确诊断穿孔。就诊年龄48 h的延迟诊断患儿可伴发严重感染。穿孔可发生于术前或手术解除梗阻以后。其穿孔多位于结肠或直肠,结肠和直肠应作为手术时探查的重点区域,彻底切除病变组织并行穿孔近端肠造口是救治患儿的合理手术方式。
[Abstract]:Objective: to investigate the clinical features, surgical methods and prognosis of anorectal malformation complicated with perforation in newborns, in order to provide reasonable data for clinical diagnosis and treatment. Methods: 11 newborns with anorectal malformation complicated with perforation were selected from January 2006 to December 2016. The clinical data were analyzed retrospectively, and the clinical features, diagnosis and treatment were summarized. Results: there were 7 cases of low deformity, 4 cases of middle and high deformity, 10 cases of male and 1 case of female. All the 3 patients with septic shock at admission were 48 hours old. The main symptoms of the disease were abdominal distension and progressive aggravation. There were 3 cases of sudden abdominal distension after anoplasty or colostomy, 4 cases of bile or fecal juice vomiting, 10 cases of abdominal plain film showing free gas under diaphragm, 3 cases of spontaneous discharge after giving up the operation. There were 5 cases of perforation of rectoentery and 3 cases of colonic perforation. All of them were treated with perforation proximal enterostomy after radical resection of pathological tissue. 3 cases were discharged from hospital automatically within 1 day after enterostomy. In the remaining 5 cases, there were no other symptoms of digestive tract discomfort except for 2 cases of high deformity defecation. Conclusion: neonatal anorectal malformation complicated with perforation is characterized by progressive abdominal distension or fecal vomiting with bile. Pneumoperitoneum can be used to diagnose perforation. The delayed diagnosis of 48 h was associated with severe infection. Perforation may occur preoperatively or after surgical relief of obstruction. Most of the perforations were located in the colon or rectum, and the colon and rectum should be the key area of exploration during the operation. It is a reasonable operation method to completely remove the pathological tissue and perforate the proximal enterostomy to treat the children.
【作者单位】：南京医科大学附属儿童医院外科ICU;南京医科大学附属儿童医院新生儿外科;
【基金】：南京市卫生局重点项目(ZKX14014)
【分类号】：R726.5

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