新生儿胎粪性肠梗阻21例诊治分析

目的：探讨新生儿胎粪性肠梗阻的诊疗经验，提高新生儿外科医师对该病的认识。方法回顾性分析本院2002年至2012年收治的21例胎粪性肠梗阻患儿临床资料。结果21例中，17例为单纯型，4例为复杂型；20例行稀释泛影葡胺灌肠造影，依靠该检查明确诊断5例，其中3例经非手术治疗痊愈。18例手术患儿中，14例单纯型行急诊手术治疗，其中10例采用肠管切开灌洗＋肠造瘘术（7例采用回肠双腔造瘘术，3例采用回肠Bishop-Koop造瘘术），4例采用阑尾切除、肠内灌洗术（3例留置阑尾造瘘管）。4例复杂型均行急诊手术，2例采用回肠双腔造瘘术，2例术中放弃治疗。18例手术患儿中，16例术后恢复良好，10例造瘘患儿术后7～16周行造瘘还纳术。结论稀释泛影葡胺灌肠造影既能有效协助诊断，又能使少部分患儿治愈；Bishop-Koop造瘘术为首选术式；胎粪较易排出的患儿可选用阑尾切除、肠内灌洗术。

The experience in diagnosis and treatment of meconium ileus

Objetive To summarize the experience in the diagnosis and treatment of meconium ileus, Help neonatal surgeon to improve the recognition of meconium ileus. Methods From 2002 to 201 2,the clini-cal data of 21 cases with meconium ileus were analyzed retrospectively. Results The 1 7 cases were simple type,4 cases were complex type,20 cases was examined with dilute gastrografin enema.5 cases of them made the definite diagnosis and 3 cases made treatment.1 4 cases of simple type underwent emergency surgery.1 0 ca-ses was performed ileum incision enema＋ileostomy（7 cases was applied double barrel ileostomy,3 cases was applied Bishop-Koop ileostomy）,4 cases was applied cleansing enema through the stem of appendix and 3 ca-ses of them were applied indwelling appendix stoma.4 cases of complex type were underwent emergency surger-y,2 cases of them were applied double barrel ileostomy,the orther 2 cases of them were abandoned therapy. The postoperative recovery of 1 6 cases was good,1 0 cases were performed successfully ileostomy closure in postoperative 7-1 6 weeks. Conclusion Dilute gastrografin enema is not only a kind of diagnosis method but also is a kind of therapy;Bishop-Koop ileostomy is the principal choice;For mild cases cleansing enema through the stem of appendix could be chosen.