本文選題：橫結(jié)腸袢式造口術(shù) + 先天性肛門直腸畸形　； 參考：《第三軍醫(yī)大學(xué)學(xué)報》2017年18期

【摘要】：目的探討并總結(jié)橫結(jié)腸袢式造口術(shù)在先天性肛門直腸畸形患兒分期治療中的優(yōu)缺點。方法回顧性分析62例先天性肛門直腸畸形患兒行預(yù)防性橫結(jié)腸袢式造瘺術(shù)后的臨床表現(xiàn)及相關(guān)重要輔助檢查;綜合分析該造口手術(shù)對先天性肛門直腸畸形患兒整個治療過程的影響,并分析原因。結(jié)果 (1)62例患兒二期和三期術(shù)前血常規(guī)結(jié)果顯示分別有21例(33.9%)vs 22例(35.5%)發(fā)生輕度貧血;無重度及極重度貧血發(fā)生。(2)62例患兒二期和三期術(shù)前分別有5例(8.1%)vs 1例(1.6%)出現(xiàn)輕度低蛋白血癥。(3)62例患兒二期術(shù)前外周血電解質(zhì)檢查顯示,7例(11.3%)出現(xiàn)輕度電解質(zhì)紊亂,其中6例在三期術(shù)前完全恢復(fù),無高氯血癥發(fā)生。(4)62例患兒尿常規(guī)結(jié)果顯示,二期和三期術(shù)前分別有19例(30.7%)vs 4例(6.4%)尿液白細胞數(shù)目異常,數(shù)目為(124.42±106.33)vs(74.75±52.89)個/μL,僅有1例出現(xiàn)明顯尿路感染癥狀。(5)57例患兒在二期術(shù)前經(jīng)橫結(jié)腸造口行遠端造影均能明確異常瘺管位置,與術(shù)中發(fā)現(xiàn)完全一致(100%),并將造影測得直腸盲端與肛隱窩間距離(34.63±6.01)mm,與術(shù)中實際測得距離(37.33±6.17)mm比較,差異無統(tǒng)計學(xué)意義(t=0.066,P0.05)。(6)62例患兒造口隨訪觀察結(jié)果顯示無嚴重腸管回縮及脫垂。結(jié)論橫結(jié)腸袢式造口術(shù)應(yīng)用于先天性肛門直腸畸形患兒分期治療,具有操作簡單,并發(fā)癥少,且對患兒營養(yǎng)狀況及生長發(fā)育無嚴重不良影響。
[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 鹵106.33)vs(74.75 鹵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 鹵6.01 mm and 37.33 鹵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.
【作者單位】： 重慶醫(yī)科大學(xué)附屬兒童醫(yī)院胃腸新生兒外科兒童發(fā)育疾病研究教育部重點實驗室兒科學(xué)重慶市重點實驗室 重慶市兒童發(fā)育重大疾病診治與預(yù)防國際科技合作基地;
【基金】：國家臨床重點�？平ㄔO(shè)項目(國衛(wèi)辦醫(yī)函[2013]544) 重慶市衛(wèi)計委醫(yī)學(xué)科研重點項目(20141010)~~
【分類號】：R726.5
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本文編號：1883515