Rescorla F J, Grosfeld J L, West K J, Vane D W
Department of Surgery, Indiana University School of Medicine, Indianapolis.
Arch Surg. 1989 Jul;124(7):837-40. doi: 10.1001/archsurg.1989.01410070095019.
This report describes 51 neonates with meconium ileus and emphasizes a changing pattern of treatment and improved survival. Twenty-four neonates had uncomplicated meconium ileus due to inspissated meconium obstructing the distal ileum. Twenty-seven neonates had 41 complications of meconium ileus including volvulus (18), bowel atresia (13), perforation (5), and giant cystic meconium peritonitis (5). Nine patients with uncomplicated cases responded to nonoperative clearing of meconium using a meglumine diatrizoate (Gastrografin) enema. Six of 7 patients with enema failures underwent laparotomy, purse-string enterotomy, and intraluminal irrigation. The remaining 9 patients with uncomplicated meconium ileus had resection and enterostomy. Complicated cases were managed by resection and anastomosis (13) or enterostomy (14). Survival at 1 year was 92% in patients with uncomplicated meconium ileus and 85% for those with complicated meconium ileus. Nonoperative Gastrografin enema or enterotomy-irrigation can relieve obstruction in uncomplicated meconium ileus and avoid an enterostomy in most cases.
本报告描述了51例胎粪性肠梗阻新生儿，并强调了治疗模式的变化及生存率的提高。24例新生儿因黏稠胎粪阻塞回肠末端而患有单纯性胎粪性肠梗阻。27例新生儿有41种胎粪性肠梗阻并发症，包括肠扭转（18例）、肠闭锁（13例）、穿孔（5例）和巨大囊性胎粪性腹膜炎（5例）。9例单纯性病例通过使用泛影葡胺（ Gastrografin）灌肠非手术清除胎粪得到缓解。7例灌肠失败的患者中有6例行剖腹探查、荷包式肠切开术和肠腔内冲洗。其余9例单纯性胎粪性肠梗阻患者行肠切除和肠造口术。复杂性病例采用肠切除吻合术（13例）或肠造口术（14例）治疗。单纯性胎粪性肠梗阻患者1年生存率为92%，复杂性胎粪性肠梗阻患者为85%。非手术泛影葡胺灌肠或肠切开冲洗可缓解单纯性胎粪性肠梗阻的梗阻，且在大多数情况下可避免肠造口术。
