Huang W H, Fang Y F, Lin Y, Zhang B, Liu M K, Bai J X, Chen F, He Y B, Wu D M
Department of Pediatric Surgery, Fujian Provincial Maternity and Children's Hospital, affiliated hospital of Fujian Medical University, Fuzhou, 350001, China.
Zhonghua Yi Xue Za Zhi. 2020 Feb 18;100(6):447-451. doi: 10.3760/cma.j.issn.0376-2491.2020.06.010.
To compare and analyze the curative effect of three surgical methods in the treatment of small intestine atresia, and to provide evidence for individualized surgical treatment of children with small intestine atresia. The clinical diagnosis and treatment of 168 children with small intestine Ⅱ, Ⅲ, Ⅳ type atresia in our hospital from January 2008 to September 2017 were retrospectively analyzed and they were divided into different types according to the operation. The three groups were end-to-end anastomosis group (EEA, 58), end oblique anastomosis group (EOA, 68), and proximal end-end anastomosis group (PEA, 42). The EEA group and the EOA group were further divided into group a (EEA-a/EOA-a) with a proximal intestinal tube diameter greater than 4.0 times the distal end and a group b ((EEA-b/EOA-b) with a diameter less than or equal to 4.0 times the distal intestinal tube diameter. The gender, gestational age, birth weight, type of atresia, and postoperative defecation time, postoperative feeding time, postoperative hospital stay and postoperative follow-up complications were compared. There was no significant difference in gender, gestational age and birth weight between the groups (0.05). The PEA group was better than EEA-a group and EOA-a group in postoperative defecation time, postoperative feeding time, postoperative hospital stay and complications (0.05). The postoperative defecation time, postoperative feeding time, postoperative hospital stay and complications of the EOA-a group were better than those of the EEA-a group (0.05). There was no statistically significant difference in postoperative defecation time, postoperative feeding time, and complications between the EEA-b group and the EOA-b group (0.05), but the postoperative hospital stay in the EEA-b group was longer than that in the EOA-b group (0.05). PEA is recommended for children with a proximal intestinal canal diameter greater than 4.0 times greater than the distal end because of the rapid recovery and fewer complications; EOA is recommended for children with a proximal intestinal canal diameter of 4.0 or less because of its advantage of shorter hospital stay than EEA surgery. Congenital intestinal atresia has a better effect according to the specific conditions of the child.
比较分析三种手术方法治疗小肠闭锁的疗效，为小肠闭锁患儿的个体化手术治疗提供依据。回顾性分析2008年1月至2017年9月我院收治的168例Ⅱ、Ⅲ、Ⅳ型小肠闭锁患儿的临床诊治情况，根据手术方式将其分为不同类型。三组分别为端端吻合组（EEA，58例）、端斜吻合组（EOA，68例）和近端端端吻合组（PEA，42例）。EEA组和EOA组又根据近端肠管直径大于远端4.0倍分为a组（EEA-a/EOA-a）和直径小于或等于远端肠管直径4.0倍的b组（EEA-b/EOA-b）。比较各组患儿的性别、胎龄、出生体重、闭锁类型以及术后排便时间、术后进食时间、术后住院时间和术后随访并发症情况。各组间性别、胎龄和出生体重差异无统计学意义（P>0.05）。PEA组术后排便时间、术后进食时间、术后住院时间及并发症情况均优于EEA-a组和EOA-a组（P<0.05）。EOA-a组术后排便时间、术后进食时间、术后住院时间及并发症情况均优于EEA-a组（P<0.05）。EEA-b组和EOA-b组术后排便时间、术后进食时间及并发症差异无统计学意义（P>0.05），但EEA-b组术后住院时间长于EOA-b组（P<0.05）。对于近端肠管直径大于远端4.0倍的患儿，推荐采用PEA，因其恢复快、并发症少；对于近端肠管直径为4.0及以下的患儿，推荐采用EOA，因其住院时间比EEA手术短。先天性肠闭锁根据患儿具体情况治疗效果较好。
