Harberg F J, Senekjian E K, Pokorny W J
J Pediatr Surg. 1981 Feb;16(1):61-3. doi: 10.1016/s0022-3468(81)80117-0.
There are many treatment modalities for uncomplicated meconium ileus. However, for neonates with intestinal obstruction unrelieved by nonoperative measures we advocate T-tube ileostomy with postoperative irrigation of the intestine utilizing pancreatic enzyme. Our series includes 11 infants with uncomplicated meconium ileus who underwent T-tube ileostomy 24--96 hr after birth. Of the 7 females and 4 males only 2 infants failed to pass meconium. One infant required reexploration for persistent obstruction and 1 infant, the only death encountered, had overwhelming pulmonary infection and intracranial hemorrhage. The remaining 9 infants passed meconium between the 1st and 11th postop days. The T-tube was removed by pulling it out between the 10th and the 14th postop day with the T-tube tract closing spontaneously in all patients. Our experience with T-tube ileostomy suggests that resection of dilated but viable ileum is not necessary for prompt intestinal function in the neonate. With the use of pancreatic enzyme irrigation, the tenacious meconium in these patients can be rapidly liquified and expelled per rectum or T-tube and the necessity of mechanical removal during the operative procedure avoided.
对于单纯性胎粪性肠梗阻有多种治疗方式。然而，对于非手术措施无法缓解肠梗阻的新生儿，我们主张行T管回肠造口术，并在术后使用胰酶进行肠道灌洗。我们的病例系列包括11例单纯性胎粪性肠梗阻的婴儿，他们在出生后24至96小时接受了T管回肠造口术。在7名女性和4名男性中，只有2名婴儿未排出胎粪。1名婴儿因持续性梗阻需要再次探查，1名婴儿（唯一的死亡病例）发生了严重的肺部感染和颅内出血。其余9名婴儿在术后第1天至第11天排出了胎粪。T管在术后第10天至第14天通过拔出取出，所有患者的T管通道均自行闭合。我们对T管回肠造口术的经验表明，对于新生儿肠道功能的迅速恢复，切除扩张但仍有活力的回肠并非必要。通过使用胰酶灌洗，这些患者黏稠的胎粪可迅速液化并经直肠或T管排出，从而避免了手术过程中机械清除的必要性。
