Mak G Z, Harberg F J, Hiatt P, Deaton A, Calhoon R, Brandt M L
Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
J Pediatr Surg. 2000 Feb;35(2):349-52. doi: 10.1016/s0022-3468(00)90038-1.
BACKGROUND/PURPOSE: The T-tube ileostomy was first used at Texas Children's Hospital in 1959. The purpose of this study is to update the experience since the initial report of this technique in 1981.
A database of 448 patients with cystic fibrosis (CF) seen in the authors' institution was used to identify 83 patients (18.5%) who presented with meconium ileus. The clinic and hospital charts of these patients were reviewed retrospectively to identify patients who had undergone placement of a T-tube ileostomy.
Surgery was performed in 60 of 83 patients for complications of meconium ileus or failure to evacuate the meconium after a contrast enema. Of these patients, 21 of 60 (35%) underwent placement of a T-tube ileostomy. An additional 8 patients were identified who underwent placement of a T-tube ileostomy but were not included in the CF database, for a total of 29 patients who have been treated with T-tube ileostomy since 1959 at Texas Children's Hospital. Five patients were excluded from analysis because of insufficient data or misdiagnosis. One of the 24 patients in the series died of complications of prematurity. A total of 20 of 23 patients had resolution of their meconium ileus after T-tube irrigation with n-acetylcysteine or pancreatic enzymes. Three patients required additional surgery to relieve persistent bowel obstruction. All patients had the T-tube removed within the first 8 weeks after surgery. Two patients required subsequent repair of an incisional hernia. There were otherwise no complications of this procedure, with an average follow-up of 11.5 years.
In patients with uncomplicated meconium ileus unrelieved by contrast enema, the T-tube ileostomy is an effective and safe treatment.
背景/目的：1959年，德克萨斯儿童医院首次使用T型管回肠造口术。本研究的目的是更新自1981年首次报道该技术以来的经验。
利用作者所在机构的448例囊性纤维化（CF）患者数据库，确定83例（18.5%）出现胎粪性肠梗阻的患者。对这些患者的临床和医院病历进行回顾性分析，以确定接受T型管回肠造口术的患者。
83例患者中有60例因胎粪性肠梗阻并发症或造影剂灌肠后胎粪未排出而接受手术。在这些患者中，60例中有21例（35%）接受了T型管回肠造口术。另外还确定了8例接受T型管回肠造口术但未纳入CF数据库的患者，自1959年以来，德克萨斯儿童医院共有29例患者接受了T型管回肠造口术治疗。5例患者因数据不足或误诊被排除在分析之外。该系列中的24例患者中有1例死于早产并发症。23例患者中有20例在使用N-乙酰半胱氨酸或胰酶进行T型管冲洗后胎粪性肠梗阻得到缓解。3例患者需要额外的手术来缓解持续性肠梗阻。所有患者均在术后8周内拔除T型管。2例患者随后需要修复切口疝。除此之外，该手术无并发症发生，平均随访11.5年。
对于造影剂灌肠无法缓解的单纯性胎粪性肠梗阻患者，T型管回肠造口术是一种有效且安全的治疗方法。
