Ohashi Kensuke, Koshinaga Tsugumichi, Uehara Shuichiro, Furuya Takeshi, Kaneda Hide, Kawashima Hiroyuki, Ikeda Taro
Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan.
Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan.
J Pediatr Surg. 2017 Nov;52(11):1873-1877. doi: 10.1016/j.jpedsurg.2017.08.009. Epub 2017 Aug 15.
In recent years, improved survival rates of extremely low birth weight infants (ELBWIs) have led to an increasing number of enterostomy performed for those with meconium obstruction of prematurity (MOP), spontaneous intestinal perforation (SIP). To prevent serious stoma-related complications such as stoma side perforation, prolapse, fall and surgical site infection, we introduce our new "sutureless enterostomy" technique.
We present the procedures in detail. We reviewed the medical records of twelve patients who underwent "sutureless enterostomy" in our neonatal intensive care unit from 2007 to 2013. Patient attributes, surgery-related items, stoma-related complications and outcomes were investigated.
Mean birth weight was 671±158g (mean±S.D.). Six cases of MOP, three cases of SIP and three cases of NEC were diagnosed. Mean operative time was 75±35min (mean±S.D.) None of them presented any of early stoma-related complications (necrosis, fall, and surgical site infection). However the parastomal hernia occurred in one patient as late complication. Three deaths occurred postoperatively as a result of exacerbations of their conditions.
Based on our preliminary observations, our new "sutureless enterostomy" was done safely and reduced the risk of stoma-related complications. It may be an ideal procedure for the ELBWI with MOP or SIP.
近年来,极低出生体重儿(ELBWIs)存活率的提高导致因早产胎粪性肠梗阻(MOP)、自发性肠穿孔(SIP)而接受肠造口术的患儿数量增加。为预防严重的造口相关并发症,如造口旁穿孔、脱垂、脱落及手术部位感染,我们引入了新的“无缝合肠造口术”技术。
我们详细介绍了手术步骤。回顾了2007年至2013年在我们新生儿重症监护病房接受“无缝合肠造口术”的12例患者的病历。调查了患者特征、手术相关项目、造口相关并发症及结局。
平均出生体重为671±158g(均值±标准差)。诊断出6例MOP、3例SIP和3例坏死性小肠结肠炎(NEC)。平均手术时间为75±35分钟(均值±标准差)。他们均未出现任何早期造口相关并发症(坏死、脱落及手术部位感染)。然而,1例患者出现了造口旁疝这一晚期并发症。3例患者术后因病情加重死亡。
基于我们的初步观察,我们的新“无缝合肠造口术”实施安全,降低了造口相关并发症的风险。对于患有MOP或SIP的ELBWI来说,这可能是一种理想的手术方式。