摘要
目的评估系膜成形联合经鼻置空肠营养管治疗新生儿高位空肠Ⅲb型闭锁的有效性。方法回顾分析南京医科大学附属儿童医院收治的21例先天性高位空肠Ⅲb型闭锁新生儿的临床资料,其中2013年1月至2015年12月共收治10例,手术采用肠切除肠吻合术,术中未经鼻留置空肠营养管(对照组);2016年1月至2019年4月共收治11例,手术方法采用系膜成形,同时术中经鼻留置空肠营养管(系膜成形组)。比较两组患儿术后首次经肛门排便时间、经口喂养时间、静脉营养时间;比较术后并发症发生情况。随访患儿的生长发育情况。结果系膜成形组术后首次排便时间、经口喂养时间及静脉营养时间均较对照组提前[2.8(1.7,3.5)d与5.0(5.0,6.0)d,P<0.05;14.0(13.0,15.3)d与19.5(18.3,20.8)d,P<0.05;30.0(29.5,56.3)d与57.5(56.3,66.3)d,P<0.05]。两组术后均未发生吻合口瘘,但系膜成形组肠梗阻发生率及术后再手术率明显低于对照组[10%与75%,P=0.009;0与62.5%,P=0.007],直接胆红素最高值明显低于对照组[24.3(12.1,44.3)μmol/L与60.3(21.5,69.0)μmol/L,P<0.05]。随访12~72个月,两组患儿生长发育位于正常儿童生长发育中位数以下、-2个标准差以内。结论系膜成形联合经鼻留置空肠营养早期肠内营养治疗新生儿高位空肠ⅢB型闭锁可促进术后肠功能恢复、减少静脉营养使用、减少术后并发症,远期随访患儿生长发育基本正常。
Objective To evaluate the efficacy of mesenteric plasty plus transnasal placement of jejunal feeding tube for correcting high jejunalⅢb atresia.Methods From January 2013 to April 2019,retrospective study was performed for 21 operated neonates with high jejunalⅢb atresia.Intestinal anastomosis without jejunal nutrition tube was performed for 4 boys and 6 girls admitted from January 2013 to December 2015(control group).And 5 boys and 6 girls admitted from January 2016 to April 2019 underwent primary anastomosis plus mesenteric plasty and transnasal placement of jejunal feeding tube(mesenteric plasty group).Time for initial anal defecation,time for oral feeding,time of parenteral nutrition and postoperative complications(intestinal obstruction,anastomotic leakage,reoperation,cholestasis&sepsis)were compared for assessing the efficacy of mesenteric plasty plus transnasal placement of jejunal feeding tube for high jejunalⅢb atresia.Future growth and development were assessed during a follow-up period of 12 to 72 months.Results Time for initial anal defecation,time for oral feeding and total time of parenteral nutrition were shorter in mesenteric plasty group than those in control group[2.8(1.7,3.5)vs 5.0(5.0,6.0)days,P<0.05;14.0(13.0,15.3)vs 19.5(18.3,20.8)days,P<0.05;30.0(29.5,56.3)vs 57.5(56.3,66.3)days,P<0.05].No anastomotic leakage occurred.The rates of postoperative intestinal obstruction and reoperation were lower in mesenteric plasty group than those in control group[10%vs 75%,P=0.009;0 vs 62.5%,P=0.007].No difference existed in the incidence of sepsis or cholestasis.However,the peak level of serum direct bilirubin was lower in mesenteric plasty group than that in control group[24.4(12.1,44.3)vs 60.3(21.5,69.0)μmol/L,P<0.05].Long-term follow-ups revealed that growth and development lagged below the median levels within a standard deviation of-2 as compared with normal controls.Conclusions Mesenteric plasty plus transnasal placement of jejunal feeding tube is effective in promoting postoperative intestinal function recovery,minimizing the use of parenteral nutrition and lowering the occurrence of postoperative complications.And growth and development normalize during long-term follow-ups.
作者
路长贵
耿其明
陈焕
李薇
蒋维维
吕小逢
张杰
唐维兵
Lu Changgui;Geng Qiming;Chen Huan;Li Wei;Jiang Weiwei;Lyu Xiaofeng;Zhang Jie;Tang Weibing(Department of Neonatal Surgery,Affiliated Children's Hospital,Nanjing Medical University,Nanjing 210008,China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2020年第12期1084-1089,共6页
Chinese Journal of Pediatric Surgery
基金
南京市科技发展项目(201723006)
江苏省社会发展重点研发项目(BE2017609)。
关键词
肠闭锁
系膜成形
空肠营养管
Intestinal atresia
Mesenteric plasty
Jejunal feeding tube
