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小儿回肠-盲肠重复畸形 115 例单中心诊治经验

Ileocecal duplication in children: a single-center experience of 115 cases.

机构信息

Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.

Department of Emergency Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.

出版信息

Eur J Pediatr. 2022 Nov;181(11):3937-3944. doi: 10.1007/s00431-022-04611-8. Epub 2022 Sep 12.

Abstract

UNLABELLED

To evaluate the clinical features, surgical management, and prognosis of ileocecal duplication in children. A total of 115 patients diagnosed with ileocecal duplication at Beijing Children's Hospital between January 2010 and June 2021 were retrospectively reviewed. Ileocecal duplications were divided into ileal intraluminal (n = 41), ileal extraluminal (n = 24), ileocecal valve (n = 11), cecal intraluminal (n = 18), and cecal extraluminal (n = 3) types according to their locations. Median age at diagnosis was 9.5 (0.1-169.2) months. Intussusception was only observed preoperatively in patients with the ileal intraluminal (8/41), ileocecal valve (4/11), and cecal intraluminal (7/18) types (P = 0.004). Ileocecal resection and ileocolostomy and cyst excision without ileocecal resection were performed in 41 (35.7%) and 74 (64.3%) patients, respectively. The proportions of cyst excision without ileocecal resection performed in patients with different types were 78.0% (32/41), 91.7% (22/24), 27.3% (3/11), 27.8% (5/18), and 100.0% (3/3) (P < 0.001). Time of oral intake (P = 0.003) and hospital stay after surgery (P < 0.001) were significantly shorter in patients undergoing cyst excision without ileocecal resection. There were no significant differences in the complications, growth, and stool frequency (older than 4 years) between patients undergoing different surgical procedures. Regarding the stool consistency (older than 4 years), there was a lower proportion of dry stool in patients undergoing cyst excision (P = 0.008).

CONCLUSIONS

Ileocecal duplications at specific locations are prone to intussusception and can influence the surgical procedure choice. At mid-term follow-up, the children's growth and defecation patterns do not seem to be affected by ileocecal resection.

WHAT IS KNOWN

• How to address ileocecal duplication has always been challenging in clinical management. • Children who have an ileocecal resection can develop some early postoperative complications.

WHAT IS NEW

• Ileocecal duplications at specific locations are prone to intussusception and can influence the surgical procedure choice. • Children's growth and defecation patterns do not seem to be affected by ileocecal resection.

摘要

目的

评估儿童回盲部重复畸形的临床特征、手术治疗方法和预后。

方法

回顾性分析 2010 年 1 月至 2021 年 6 月期间在北京儿童医院诊断为回盲部重复畸形的 115 例患儿的临床资料。根据病变位置,将回盲部重复畸形分为回肠腔内型(41 例)、回肠腔外型(24 例)、回盲瓣型(11 例)、盲肠腔内型(18 例)和盲肠腔外型(3 例)。患儿的中位年龄为 9.5(0.1-169.2)个月。术前仅观察到回肠腔内型(8/41)、回盲瓣型(4/11)和盲肠腔内型(7/18)患儿存在肠套叠(P=0.004)。41 例患儿接受回肠切除+回肠结肠吻合术,74 例患儿接受单纯囊肿切除术而未行回肠切除。不同类型患儿中接受单纯囊肿切除术而未行回肠切除的比例分别为 78.0%(32/41)、91.7%(22/24)、27.3%(3/11)、27.8%(5/18)和 100.0%(3/3)(P<0.001)。未行回肠切除的患儿术后开始经口进食时间(P=0.003)和住院时间(P<0.001)均明显缩短。不同手术方式患儿术后并发症、生长情况和(年龄大于 4 岁)排便频率无显著差异。在(年龄大于 4 岁)大便性状方面,未行回肠切除的患儿中干便比例较低(P=0.008)。

结论

特定位置的回盲部重复畸形易发生肠套叠,影响手术方式选择。在中期随访中,患儿的生长和排便模式似乎不受回肠切除术的影响。

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