Sapin E, Carricaburu E, De Boissieu D, Goutail-Flaud M F, Benammar S, Helardot P G
Department of Pediatric Surgery, Hôpital St Vincent de Paul, CHU Cochin Port-Royal, University School of Medicine René Descartes, Paris, France.
Eur J Pediatr Surg. 1999 Feb;9(1):24-8. doi: 10.1055/s-2008-1072207.
Neonates with multiple sites of intestinal atresia (MIA) may be predisposed to short-gut syndrome. Anastomoses of the intervening segments may prevent this complication. 5 neonates with MIA, one of them with a gastroschisis, were operated on: a proximal enterostomy was constructed, a side-to-end anastomosis as described by Santulli and several end-to-end anastomoses between the intervening intestinal segments (n = 3 to 7) were performed. An additional infant, initially operated on for a necrotizing enterocolitis (NEC) was managed with the same surgical procedure. Without use of this technique, the remaining length of small intestine would have been 28, 27, 40, 58, 70 and 7 cm. This technique enabled an intestinal length of 49, 54, 96, 107, 92 and 93 cm respectively to be achieved. Ileocecal valve was present in all 5 cases with MIA, but resected in the case with NEC. The enterostomy was reversed 7 weeks later. The initial outcome (delay of enteral feeding, duration of parenteral nutrition) was good: the babies were weaned from parenteral nutrition (PN) after a mean time of 90 days (48 to 163 days). The prognosis (mean follow-up: 31 months, range 14 to 57) was good with regards to growth and development and length of time required before adaptation to normal enteral feedings and stools. This surgical method allows complete decompression of the proximal jejunum so that nutriment can pass into the distal bowel allowing it to enlarge. In cases of MIA, a long tapering proximal enteroplasty is a better procedure than resecting more than 5-10 cm of the proximal distended and hypertrophied bowel. We prefer to perform an enterostomy in association with multiple anastomoses between intervening intestinal segments. The enterostomy is preserved for long enough waiting period to enable the reversion of the histochemical and morphological changes that may have taken place in the bowel.
患有多处肠道闭锁（MIA）的新生儿可能易患短肠综合征。中间肠段的吻合术或许可预防这一并发症。对5例患有MIA的新生儿进行了手术，其中1例合并腹裂：构建近端肠造口术，按照Santulli所述进行端侧吻合，并在中间肠段之间进行了多次端端吻合（n = 3至7次）。另外1例最初因坏死性小肠结肠炎（NEC）接受手术的婴儿也采用了相同的手术方法。若不采用此技术，剩余小肠长度分别为28、27、40、58、70和7厘米。而此技术分别使小肠长度达到了49、54、96、107、92和93厘米。所有5例MIA患儿均存在回盲瓣，但NEC患儿的回盲瓣被切除。7周后将肠造口术还纳。初始结果（肠内喂养延迟、肠外营养持续时间）良好：婴儿在平均90天（48至163天）后停止肠外营养（PN）。就生长发育以及适应正常肠内喂养和排便所需的时间而言，预后良好（平均随访：31个月，范围14至57个月）。这种手术方法可使近端空肠完全减压，以便营养物质能进入远端肠管使其扩张。在MIA病例中，长的渐细近端肠成形术比切除近端扩张和肥厚肠管超过5 - 10厘米的手术更好。我们更倾向于在中间肠段之间进行多次吻合的同时行肠造口术。保留肠造口术足够长的等待期，以使肠内可能发生的组织化学和形态学变化得以逆转。
