损伤控制肠造口术在急性肠道疾病所致腹膜炎患儿治疗中的作用

Role of damage control enterostomy in management of children with peritonitis from acute intestinal disease.

作者信息

Ameh Emmanuel A, Ayeni Michael A, Kache Stephen A, Mshelbwala Philip M

机构信息

Department of Surgery, Division of Paediatric Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.

出版信息

Afr J Paediatr Surg. 2013 Oct-Dec;10(4):315-9. doi: 10.4103/0189-6725.125429.

DOI:10.4103/0189-6725.125429

PMID:24469480

Abstract

BACKGROUND

Intestinal anastomosis in severely ill children with peritonitis from intestinal perforation, intestinal gangrene or anastomotic dehiscence (acute intestinal disease) is associated with high morbidity and mortality. Enterostomy as a damage control measure may be an option to minimize the high morbidity and mortality. This report evaluates the role of damage control enterostomy in the treatment of these patients.

MATERIALS AND METHODS

A retrospective review of 52 children with acute intestinal disease who had enterostomy as a damage control measure in 12 years.

RESULTS

There were 34 (65.4%) boys and 18 (34.6%) girls aged 3 days-13 years (median 9 months), comprising 27 (51.9%) neonates and infants and 25 (48.1%) older children. The primary indication for enterostomy in neonates and infants was intestinal gangrene 25 (92.6%) and perforated typhoid ileitis 22 (88%) in older children. Enterostomy was performed as the initial surgery in 33 (63.5%) patients and as a salvage procedure following anastomotic dehiscence in 19 (36.5%) patients. Enterostomy-related complications occurred in 19 (36.5%) patients, including 11 (21.2%) patients with skin excoriations and eight (15.4%) with hypokalaemia. There were four (7.7%) deaths (aged 19 days, 3 months, 3½ years and 10 years, respectively) directly related to the enterostomy, from hypokalaemia at 4, 12, 20 and 28 days postoperatively, respectively. Twenty other patients died shortly after surgery from their primary disease. Twenty of 28 surviving patients have had their enterostomy closed without complications, while eight are awaiting enterostomy closure.

CONCLUSION

Damage-control enterostomy is useful in management of severely ill children with intestinal perforation or gangrene. Careful and meticulous attention to fluid and electrolyte balance, and stoma care, especially in the first several days following surgery, are important in preventing morbidity and mortality.

摘要

背景

患有肠穿孔、肠坏疽或吻合口裂开（急性肠道疾病）所致腹膜炎的重症患儿进行肠道吻合术，其发病率和死亡率较高。作为一种损伤控制措施的肠造口术可能是将高发病率和死亡率降至最低的一种选择。本报告评估损伤控制肠造口术在这些患者治疗中的作用。

材料与方法

回顾性分析12年间52例接受肠造口术作为损伤控制措施的急性肠道疾病患儿。

结果

共34名（65.4%）男孩和18名（34.6%）女孩，年龄3天至13岁（中位数9个月），其中27名（51.9%）为新生儿和婴儿，25名（48.1%）为大龄儿童。新生儿和婴儿进行肠造口术的主要指征是肠坏疽（25例，92.6%），大龄儿童是穿孔性伤寒性回肠炎（22例，88%）。33例（63.5%）患者将肠造口术作为初次手术，19例（36.5%）患者在吻合口裂开后作为挽救手术。19例（36.5%）患者发生了与肠造口术相关的并发症，包括11例（21.2%）皮肤擦伤患者和8例（15.4%）低钾血症患者。有4例（7.7%）死亡（年龄分别为19天、3个月、3.5岁和10岁）与肠造口术直接相关，分别于术后4天、12天、20天和28天死于低钾血症。另外20例患者术后不久死于原发性疾病。28名存活患者中有20例已顺利关闭肠造口，8例正在等待关闭肠造口。