Pýcha K, Morávek J, Stranák Z, Dokoupilová M, Zoban P, Rygl M, Snajdauf J
Klinika dĕtské chirurgie, 2. LF UK, FN Motol, Praha.
Rozhl Chir. 2000 Dec;79(12):613-7.
a) assessment of the relationship between ileus of premature infants and the development of intestinal perforation in premature infants, b) suggestions of an optimal therapeutic procedure. In the study children (n = 50) are included a) with intestinal perforation in conjunction with impaired excretion of meconium (n = 22), b) with an ileus state based on obstruction of the ileum by a viscous meconium treated either surgically or conservatively (n = 28). Surgical treatment involved: a) establishment of a double ileostomy (n = 28), b) insertion of a T drain into the terminal ileum (n = 8), c) removal of meconium from the gut and its primary closure (n = 2). Conservative treatment in 11 children involved irrigography with an liquid contrast substance under X-ray control. The group of children with perforation was compared with the group of children without perforation, risk factors were evaluated by statistical methods. The necessity of ventilation (P = 0.051) and gestation age (P = 0.006) proved to be statistically significant risk factors for the development of perforation. Survival was not influenced by perforation. All 11 children treated conservatively survived, of 39 operated children 26 survived (66.7%). An early start of conservative treatment of ileus of premature infants reduces markedly the risk of intestinal perforation and can thus influence the survival of low birth weight neonates.
a) 评估早产儿肠梗阻与早产儿肠穿孔发展之间的关系，b) 提出最佳治疗方法的建议。在该研究中纳入了50名儿童：a) 伴有胎粪排出障碍的肠穿孔患儿（n = 22），b) 因黏稠胎粪阻塞回肠而处于肠梗阻状态的患儿，这些患儿接受了手术治疗或保守治疗（n = 28）。手术治疗包括：a) 建立双回肠造口术（n = 28），b) 在回肠末端插入T形引流管（n = 8），c) 清除肠道内的胎粪并进行一期缝合（n = 2）。11名儿童的保守治疗包括在X线控制下用液体造影剂进行灌肠造影。将穿孔患儿组与未穿孔患儿组进行比较，通过统计方法评估危险因素。通气必要性（P = 0.051）和胎龄（P = 0.006）被证明是穿孔发展的统计学显著危险因素。穿孔对存活率没有影响。所有11名接受保守治疗的儿童均存活，39名接受手术治疗的儿童中有26名存活（66.7%）。尽早开始对早产儿肠梗阻进行保守治疗可显著降低肠穿孔风险，从而影响低体重新生儿的存活率。
