Rosenman J E, Kosloske A M
Surgery. 1982 Jan;91(1):34-7.
We performed the Mikulicz procedure in 46 pediatric patients. Thirty-five were high-risk patients, 20 of whom had necrotizing enterocolitis. High risk was defined by the presence of peritonitis, intestinal perforation, poorly demarcated intestinal gangrene, or severe associated systemic illness. The remaining 11 patients had the procedure performed for technical reasons, most commonly a discrepancy in the size of the proximal distal limb ratio greater than 4:1. The procedure consisted of intestinal resection with double-barreled enterostomy, crushing of the spur between stomas, and subsequent lateral closure of the enterostomy. The mortality rate of 30% was due to the underlying disease and in no instance was death caused by a complication of the procedure. Complications (13%) were stricture or prolapse of the stoma and wound infection. Subsequent enterostomy closure in 32 patients had no mortality rate and a 3% complication rate. Because the risk of fatal anastomotic leak and peritonitis is very low, we prefer the Mikulicz procedure to all other intestinal anastomotic techniques for high-risk pediatric patients.
我们对46例儿科患者实施了米库利奇手术。其中35例为高危患者，20例患有坏死性小肠结肠炎。高危的定义为存在腹膜炎、肠穿孔、界限不清的肠坏疽或严重的相关全身性疾病。其余11例患者因技术原因接受了该手术，最常见的是近端与远端肢体比例大于4:1。该手术包括肠切除及双腔造口术、造口之间的肠袢压榨术以及随后的造口侧方闭合术。30%的死亡率是由基础疾病导致的，手术并发症未导致任何一例死亡。并发症发生率为13%，包括造口狭窄或脱垂以及伤口感染。32例患者随后进行的造口闭合术无死亡率，并发症发生率为3%。由于致命性吻合口漏和腹膜炎的风险非常低，对于高危儿科患者，我们更倾向于采用米库利奇手术而非其他所有肠道吻合技术。
