[1]孙静,王至立,侯金凤,等.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[J].第三军医大学学报,2017,39(18):1848-1853.
 SUN Jing,WANG Zhili,HOU Jinfeng,et al.Transverse-loop colostomy in phased treatment of congenital anorectal malformation[J].J Third Mil Med Univ,2017,39(18):1848-1853.
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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(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
39卷
期数:
2017年第18期
页码:
1848-1853
栏目:
临床医学
出版日期:
2017-09-30

文章信息/Info

Title:
Transverse-loop colostomy in phased treatment of congenital anorectal malformation
作者:
孙静 王至立 侯金凤侯金平 吴永隆 刘伟 李晓庆 王佚
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
Author(s):
SUN Jing WANG Zhili HOU Jinfeng HOU Jinping WU Yonglong LIU Wei LI Xiaoqing WANG Yi

Department of Gastrointestinal Neonatal Surgery, Key Laboratory of Child Development and Disorder of Ministry of Education, Chongqing Key Laboratory of Pediatrics, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China

关键词:
横结肠袢式造口术先天性肛门直肠畸形分期手术
Keywords:
transverse-loop colostomy congenital anorectal malformation phased surgery
分类号:
R657.1;R726.2;R726.571
文献标志码:
A
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    ①62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。   ②62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。   ③62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。   ④62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。   ⑤57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,P>0.05)。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-loop colostomy in the phased treatment of congenital anorectal malformation (ARM). Methods     A retrospective study was carried out on 62 congenital ARM children (aged from 1 to 165 d, median age of 13 d) admitted in our hospital from January 2013 to April 2016. All the children underwent protective transverse-loop colostomy as phased surgery. The clinical manifestations and results of related important auxiliary examinations were analyzed and summarized in order to determine the effects of colostomy on the whole treatment and final outcomes of ARM children. Results    ① Before anorectoplasty and colostomy closure, peripheral blood routine examination showed that only 21 cases (33.9%) and 22 cases (35.5%) of mild anemia occurred respectively in the totally 62 cases, and no severe anemia case happened. ② Serum albumin examination showed that mild hypoproteinemia occurred in 5 patients (8.1%) and 1 case (1.6%) respectively before anorectoplasty and colostomy closure. ③ Electrolyte examination showed there were 7 cases (11.3%) of mild electrolyte disorder before anorectoplasty, and 6 of them were completely recovered before the colostomy closure. There was no hyperchloremic acidosis happened. ④ Urine routine results indicated that abnormal white blood cell count  (WBC) in urine was found in 19 children (30.7%) before anorectoplasty and 4 children (6.4%) after fistula repair, and the average WBC was 124.42±106.33 and 74.75±52.89 cells/μL, respectively. Only 1 case experienced obvious symptoms of urinary tract infection. ⑤ Highpressure distal colostography displayed that the hydrosoluble contrast media were executed in 57 cases. The location of the distal rectum was  detected precisely with the abnormal fistula confirmed by anorectoplasty (100%). The distance from the distal rectum to anal crypt was 34.63±6.01 mm measured in the high-pressure distal colostogram, and 37.33±6.17 mm measured during operation, and there was no significant difference (t=0.066, P>0.05). ⑥ The 62 cases had no severe bowel retraction, stricture or prolapse stoma in the follow-up period. Conclusion     Transverse-loop colostomy can be used in the phased treatment for congenital ARM children. It is simple, and causes few complications and exerts no serious adverse effects on nutritional status and growth and development in the children.

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更新日期/Last Update: 2017-09-29