横结肠袢式造口术在先天性肛门直肠畸形分期手术中应用的临床研究

孙静; 王至立; 侯金凤; 侯金平; 吴永隆; 刘伟; 李晓庆; 王佚

doi:10.16016/j.1000-5404.201702035

您当前的位置：

首页 >

文章列表页 >

横结肠袢式造口术在先天性肛门直肠畸形分期手术中应用的临床研究

临床医学 | 更新时间：2026-01-09

- 横结肠袢式造口术在先天性肛门直肠畸形分期手术中应用的临床研究
- Transverse-loop colostomy in phased treatment of congenital anorectal malformation
- 第三军医大学学报 2017年39卷第18期页码：1848-1853
- 作者机构：
  
  400014 重庆，重庆医科大学附属儿童医院胃肠新生儿外科，儿童发育疾病研究教育部重点实验室，儿科学重庆市重点实验室，重庆市儿童发育重大疾病诊治与预防国际科技合作基地
- 作者简介：
  
  [ 王佚，E-mail：wy757311@hotmail.com WANG Yi, E-mail:wy757311@hotmail.com
- 基金信息：
  
  国家临床重点专科建设项目(国卫办医函[2013]544);重庆市卫计委医学科研重点项目(20141010)
- DOI：10.16016/j.1000-5404.201702035
  中图分类号： R657.1;R726.2;R726.571
- 收稿：2017-02-09，
  
  修回：2017-04-17，
  
  纸质出版：2017-09-30
- 稿件说明：
移动端阅览
孙静, 王至立, 侯金凤, 等. 横结肠袢式造口术在先天性肛门直肠畸形分期手术中应用的临床研究[J]. 第三军医大学学报, 2017,39(18):1848-1853.

Jing SUN, Zhili WANG, Jinfeng HOU, et al. Transverse-loop colostomy in phased treatment of congenital anorectal malformation[J]. Journal of Third Military Medical University, 2017, 39(18): 1848-1853.
孙静, 王至立, 侯金凤, 等. 横结肠袢式造口术在先天性肛门直肠畸形分期手术中应用的临床研究[J]. 第三军医大学学报, 2017,39(18):1848-1853. DOI： 10.16016/j.1000-5404.201702035.

Jing SUN, Zhili WANG, Jinfeng HOU, et al. Transverse-loop colostomy in phased treatment of congenital anorectal malformation[J]. Journal of Third Military Medical University, 2017, 39(18): 1848-1853. DOI： 10.16016/j.1000-5404.201702035.

摘要

目的

探讨并总结横结肠袢式造口术在先天性肛门直肠畸形患儿分期治疗中的优缺点。

方法

回顾性分析62例先天性肛门直肠畸形患儿行预防性横结肠袢式造瘘术后的临床表现及相关重要辅助检查；综合分析该造口手术对先天性肛门直肠畸形患儿整个治疗过程的影响，并分析原因。

结果

① 62例患儿二期和三期术前血常规结果显示分别有21例(33.9%)

22例(35.5%)发生轻度贫血；无重度及极重度贫血发生。② 62例患儿二期和三期术前分别有5例(8.1%)

1例(1.6%)出现轻度低蛋白血症。③ 62例患儿二期术前外周血电解质检查显示，7例(11.3%)出现轻度电解质紊乱，其中6例在三期术前完全恢复，无高氯血症发生。④ 62例患儿尿常规结果显示，二期和三期术前分别有19例(30.7%)

4例(6.4%)尿液白细胞数目异常，数目为(124.42±106.33)

(74.75±52.89) 个/μL，仅有1例出现明显尿路感染症状。⑤ 57例患儿在二期术前经横结肠造口行远端造影均能明确异常瘘管位置，与术中发现完全一致(100%)，并将造影测得直肠盲端与肛隐窝间距离(34.63±6.01) mm，与术中实际测得距离(37.33±6.17) mm比较，差异无统计学意义(

=0.066，

0.05)。⑥ 62例患儿造口随访观察结果显示无严重肠管回缩及脱垂。

结论

横结肠袢式造口术应用于先天性肛门直肠畸形患儿分期治疗

具有操作简单，并发症少，且对患儿营养状况及生长发育无严重不良影响。

Abstract

Objective

To investigate and summarize the advantages and disadvantages of transverse-loop colostomy in the phased treatment of congenital anorectal malformation (ARM).

Methods

A retrospective study was carried out on 62 congenital ARM children (aged from 1 to 165 d

median age of 13 d) admitted in our hospital from January 2013 to April 2016. All the children underwent protective transverse-loop colostomy as phased surgery. The clinical manifestations and results of related important auxiliary examinations were analyzed and summarized in order to determine the effects of colostomy on the whole treatment and final outcomes of ARM children.

Results

① Before anorectoplasty and colostomy closure

peripheral blood routine examination showe

d that only 21 cases (33.9%) and 22 cases (35.5%) of mild anemia occurred respectively in the totally 62 cases

and no severe anemia case happened. ② Serum albumin examination showed that mild hypoproteinemia occurred in 5 patients (8.1%) and 1 case (1.6%) respectively before anorectoplasty and colostomy closure. ③ Electrolyte examination showed there were 7 cases (11.3%) of mild electrolyte disorder before anorectoplasty

and 6 of them were completely recovered before the colostomy closure. There was no hyperchloremic acidosis happened. ④ Urine routine results indicated that abnormal white blood cell count (WBC) in urine was found in 19 children (30.7%) before anorectoplasty and 4 children (6.4%) after fistula repair

and the average WBC was 124.42±106.33 and 74.75±52.89 cells/μL

respectively. Only 1 case experienced obvious symptoms of urinary tract infection. ⑤ High-pressure distal colostography displayed that the hydrosoluble contrast media were executed in 57 cases. The location of the distal rectum was detected precisely with the abnormal fistula confirmed by anorectoplasty (100%). The distance from the distal rectum to anal crypt was 34.63±6.01 mm measured in the high-pressure distal colostogram

and 37.33±6.17 mm measured during operation

and there was no significant difference (

=0.066

0.05). ⑥ The 62 cases had no severe bowel retraction

stricture or prolapse stoma in the follow-up period.

Conclusion

Transverse-loop colostomy can be used in the phased treatment for congenital ARM children. It is simple

and causes few complications and exerts no serious adverse effects on nutritional status and growth and development in the children.

关键词

Keywords

references

LEVITT M A, PEÑA A. Imperforate anus and cloacal malformations[J]. Ashcraft's Pediatric Surgery, 2010: 468-490. DOI:10.1016/b978-1-4160-6127-4.00036-7.

HOLSCHNEIDER A, HUTSON J, PEÑA A, et al. Preliminary report on the International Conference for the development of standards for the treatment of anorectal malformations[J]. J PediatrSurg, 2005, 40(10): 1521-1526. DOI:10.1016/j.jpedsurg.2005.08.002.

LEVITT M A, PENA A. Anorectal malformations[J]. Orphanet J Rare Dis, 2007, 2: 33. DOI:10.1186/1750-1172-2-33.

吴永隆, 陈思远, 陈秀兰, 等.男性先天性中高位肛门直肠畸形术后排便功能评估及其影响因素[J].第三军医大学学报, 2015, 37(21): 2151-2155. DOI:10.16016/j.1000-5404.201503166.

WU Y L, CHEN S Y, CHEN X L, et al. Bowel function and its influencing factors for male children with high and intermediate anorectal malformation after surgical treatment[J]. J Thir Mil Med Univ, 2015, 37(21):2151-2155. DOI:10.16016/j.1000-5404.201503166.

PENA A, MIGOTTO-KRIEGER M, LEVITT M A. Colostomy in anorectal malformations: a procedure with serious but preventable complications[J]. J PediatrSurg, 2006, 41(4): 748-756. DOI:10.1016/j.jpedsurg.2005.12.021.

LIECHTY S T, BARNHART D C, HUBER J T, et al. The morbidity of a divided stoma compared to a loop colostomy in patients with anorectal malformation[J]. J PediatrSurg, 2016, 51(1): 107-110. DOI:10.1016/j.jpedsurg.2015.10.025.

PATWARDHAN N, KIELY E M, DRAKE D P,et al. Colostomy for anorectal anomalies: high incidence of complications[J]. J PediatrSurg, 2001, 36(5): 795-798. DOI:10.1053/jpsu.2001.22963.

SALEEM M, SAQI Z, SHAIKH A H, et al. Complications of colostomy in infants and children[J]. Ann KE Med Col, 1998, 4:20-23.

唐维兵, 徐小群, 耿其明, 等.新生儿结肠造瘘术165例分析[J].临床小儿外科杂志, 2008, 7(5): 41-43. DOI:10.3969/j.issn.1671-6353.2008.05.014.

TANG W B, XU X Q, GENG Q M, et al.Neonatal colostomy: report of 32 cases[J]. J Clin Pediatric Surg, 2008, 7(5): 41-43. DOI:10.3969/j.issn.1671-6353.2008.05.014.

CHANDRAMOULI B, SRINIVASAN K, JAGDISH S, et al. Morbidity and mortality of colostomy and its closure in children[J]. J PediatrSurg, 2004, 39(4): 596-599. DOI: 10.1016/j.jpedsurg.2003.12.016.

MOLLITT D L, MALANGONI M A, BALLANTINE T V, et al. Colostomy complications in children. An analysis of 146 cases[J]. Arch Surg, 1980, 115(4): 455-458. DOI:10.1001/archsurg.1980.01380040079014.

吴永隆, 陈思远, 陈秀兰, 等.男性先天性中高位肛门直肠畸形的诊断及伴发畸形评估的临床研究[J].第三军医大学学报, 2015, 37(13): 1349-1352. DOI:10.16016/j.1000-5404.201411030.

WU Y L, CHEN S Y, CHEN X L, et al. Diagnosis for high and intermediate imperforate anus in male neonates and assessment of accompaniedmalformations[J]. J Thir Mil Med Univ, 2015, 37(13):1349-1352.DOI:10.16016/j.1000-5404.201411030.

ODA O, DAVIES D, COLAPINTO K, et al. Loop versus divided colostomy for the management of anorectal malformations[J]. J PediatrSurg, 2014, 49(1): 87-90; discussion 90. DOI:10.1016/j.jpedsurg.2013.09.032.

VAN DEN HONDEL D, SLOOTS C, MEEUSSEN C, et al. To split or not to split: colostomy complications for anorectal malformations or hirschsprung disease: a single center experience and a systematic review of the literature[J]. Zeitschrift fur Kinderchirurgie, 2014, 24(1): 61-69. DOI:10.1055/s-0033-1351663.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

脊髓发育异常对先天性肛门直肠畸形患儿排便功能及生活质量的影响

先天性球形结肠的临床特点和诊治体会

先天性复杂肛门直肠畸形合并畸形的临床分析

先天性肛门直肠畸形患儿血清VA及肠组织RARα表达及意义