Verga G, Spina P, Minniti S, Verga L
Clinica di Chirurgia Pediatrica, IRCCS Policlinico, S. Matteo, Università degli Studi, Pavia.
Minerva Pediatr. 1996 Sep;48(9):365-71.
It is stated that the ileocecal valve delays the passage of ileal contents into the cecum and acts as a barrier against reflux and ascension of colonic bacterial flora into the small bowel: its resection may lead to bacterial colonization of the ileum and to abnormalities of intestinal motility, transit and absorption. In this study twenty individuals subjected in pediatric age (1 day to 11 years) to ileocecal resection have been evaluated from 2 to 19 years after surgery. Three patients underwent limited ileocecal resection, in four this was associated with a significant ileal resection, in five with extensive right colon resection and in eight with extensive ileal and right colon resection. Growth, stool habit, hematology and serum biochemistry were examined; all patients also underwent abdominal ultrasonography. In all body weight and height were within normal limits; seven had moderate diarrhea up to 18 months after surgery and two who required extensive intestinal resection (40 and 30 cm of small bowel left) had diarrhea until about 36 months after surgery: now all of them have daily fecal evacuation. Hematological, biochemical, urinary and fecal studies proved normal except in one treated with TPN who presented transaminases slightly increased and in three suffering from mucoviscidosis in whom steatorrhea with moderate alterations of fats and elevation of alkaline phosphatase and transaminases were present. Urinary and gall stones were not seen in anyone. In conclusion from this study it can be postulated that removal of ileocecal valve can be done safely in children.
据说回盲瓣可延缓回肠内容物进入盲肠,并起到屏障作用,防止结肠菌群反流和升入小肠:切除回盲瓣可能导致回肠细菌定植以及肠道运动、传输和吸收异常。在本研究中,对20例小儿(年龄从1天至11岁)回盲瓣切除术后2至19年进行了评估。3例患者接受了有限的回盲瓣切除术,4例患者同时进行了显著的回肠切除术,5例患者进行了广泛的右半结肠切除术,8例患者进行了广泛的回肠和右半结肠切除术。检查了生长情况、排便习惯、血液学和血清生化指标;所有患者还接受了腹部超声检查。所有患者的体重和身高均在正常范围内;7例患者术后18个月内有中度腹泻,2例接受广泛肠切除术(剩余40和30厘米小肠)的患者术后约36个月仍有腹泻:现在他们所有人每天都有排便。血液学、生化、尿液和粪便检查均正常,只有1例接受全胃肠外营养治疗的患者转氨酶略有升高,3例患有囊性纤维化的患者存在脂肪泻,伴有中度脂肪改变以及碱性磷酸酶和转氨酶升高。所有人均未发现尿路结石和胆结石。总之,从本研究可以推测,儿童回盲瓣切除术可以安全进行。