Lau Eugene C T, Fung Adrian C H, Wong Kenneth K Y, Tam Paul K H
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
J Pediatr Surg. 2016 Dec;51(12):1914-1916. doi: 10.1016/j.jpedsurg.2016.09.010. Epub 2016 Sep 15.
Necrotizing enterocolitis in premature neonates often results in bowel resection and stoma formation. One way to promote bowel adaptation before stoma closure is to introduce proximal loop effluents into the mucous fistula. In this study, we reviewed our experience with distal loop refeeding with respect to control group.
All patients with necrotizing enterocolitis between 2000 and 2014 necessitating initial diverting enterostomies and subsequent stoma closure in a tertiary referral center were included. Medical records were retrospectively reviewed. Demographic data, surgical procedures, and postoperative outcomes were analyzed.
92 patients were identified, with 77 patients receiving mucous fistula refeeding. The refeeding group showed less bowel ends size discrepancy (25 vs 53%, p=0.034) and less postoperative anastomotic leakage (3 vs 20%, p=0.029). Fewer refeeding group patients developed parenteral nutrition related cholestasis (42 vs 73%, p=0.045) and required shorter parenteral nutrition support (47 vs 135days, p=0.002). The mean peak bilirubin level was higher in the non-refeeding group (155 vs 275μmol/L, p<0.001). No major complication was associated with refeeding.
Mucous fistula refeeding is safe and can decrease risk of anastomotic complication and parental nutrition related cholestasis. It provides both diagnostic and therapeutic value preoperatively and its use should be advocated. Level III Treatment Study in a Case Control Manner.
早产新生儿坏死性小肠结肠炎常导致肠切除和造口形成。在造口关闭前促进肠道适应的一种方法是将近端肠袢流出物引入黏液瘘。在本研究中，我们回顾了与对照组相比，我们在远端肠袢再喂养方面的经验。
纳入2000年至2014年间在一家三级转诊中心因坏死性小肠结肠炎需要初次转流性肠造口术及随后造口关闭的所有患者。对病历进行回顾性分析。分析人口统计学数据、手术操作及术后结果。
共识别出92例患者，其中77例接受了黏液瘘再喂养。再喂养组肠端大小差异较小（25%对53%，p = 0.034），术后吻合口漏发生率较低（3%对20%，p = 0.029）。再喂养组发生肠外营养相关胆汁淤积的患者较少（42%对73%，p = 0.045），且需要的肠外营养支持时间较短（47天对135天，p = 0.002）。非再喂养组的平均胆红素峰值水平较高（155对275μmol/L，p<0.001）。再喂养未出现重大并发症。
黏液瘘再喂养安全，可降低吻合口并发症及肠外营养相关胆汁淤积的风险。它在术前具有诊断和治疗价值，应提倡使用。以病例对照方式进行的III级治疗研究。
