本文選題：橫結腸袢式造口術 + 先天性肛門直腸畸形�。� 參考：《第三軍醫(yī)大學學報》2017年18期

【摘要】：目的探討并總結橫結腸袢式造口術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防性橫結腸袢式造瘺術后的臨床表現及相關重要輔助檢查;綜合分析該造口手術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。結果 (1)62例患兒二期和三期術前血常規(guī)結果顯示分別有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前分別有5例(8.1%)vs 1例(1.6%)出現輕度低蛋白血癥。(3)62例患兒二期術前外周血電解質檢查顯示,7例(11.3%)出現輕度電解質紊亂,其中6例在三期術前完全恢復,無高氯血癥發(fā)生。(4)62例患兒尿常規(guī)結果顯示,二期和三期術前分別有19例(30.7%)vs 4例(6.4%)尿液白細胞數目異常,數目為(124.42±106.33)vs(74.75±52.89)個/μL,僅有1例出現明顯尿路感染癥狀。(5)57例患兒在二期術前經橫結腸造口行遠端造影均能明確異常瘺管位置,與術中發(fā)現完全一致(100%),并將造影測得直腸盲端與肛隱窩間距離(34.63±6.01)mm,與術中實際測得距離(37.33±6.17)mm比較,差異無統計學意義(t=0.066,P0.05)。(6)62例患兒造口隨訪觀察結果顯示無嚴重腸管回縮及脫垂。結論橫結腸袢式造口術應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重慶市重點實驗室 重慶市兒童發(fā)育重大疾病診治與預防國際科技合作基地;
【基金】：國家臨床重點�？平ㄔO項目(國衛(wèi)辦醫(yī)函[2013]544) 重慶市衛(wèi)計委醫(yī)學科研重點項目(20141010)~~
【分類號】：R726.5
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本文編號：1883515