自制引流袋在小儿肠造瘘口的应用

No abstract available     

改良式肠造口引流装置在新生儿肠造瘘中的临床应用

目的探讨改良式肠造口引流装置应用于新生儿肠造瘘手术治疗中的安全性与使用价值。方法回顾性分析南方医科大学附属东莞市妇幼保健院小儿外科2011年1月至2018年8月收治的45例需行肠造瘘新生儿的临床资料,均采用急诊或亚急诊剖腹探查术进行治疗,术中均实施了暂时性肠造瘘手术,采用随机分配的方法将45例受试者分为传统组(n=27)和改良组(n=18),两组患儿一般临床资料情况对比差异无统计学意义(P>0.05);改良组术中均在造瘘口的近端采用由包皮环和避孕套组合而成的肠造瘘引流装置,传统组近端造瘘肠管不作处理。对比两组患儿术中出血量、非计划再次手术例数、手术时间、术后住院天数和术后并发症等资料。结果45例均顺利完成手术。改良组18例,无一例死亡;传统组27例,其中1例因感染性休克并发多器官功能衰竭死亡;改良组术后并发症发生率低于传统组,差异有统计学意义(P<0.05)。改良组手术时间为(89.50±16.73)min,传统组手术时间为(86.07±17.27)min,差异无统计学意义(P>0.05)。改良组术后无一例并发症,传统组术后14例出现并发症,差异有统计学意义(P<0.05)。改良组术后住院时间为(19.89±4.54)d,传统组术后住院时间为(24.73±11.57)d,差异有统计学意义(P<0.05)。改良组非计划再次手术1例,传统组非计划再次手术10例,差异有统计学意义(P<0.05)。结论改良式肠造口引流装置应用于新生儿肠造瘘手术可有效降低肠造瘘术后的并发症发生率,并且具有操作简单、术后外形美观、护理方便等优点,值得临床推广应用。     

小儿肠造瘘术的临床应用体会

我院2000年5月至2005年5月共收治55例小儿肠造瘘病例，现将经验体会介绍如下。     

造口护肤粉与皮肤保护膜联合应用于小儿肠造瘘周围皮炎的疗效观察

肠造瘘是小儿外科一种常见有效的治疗方式。根据造瘘的部位可分为小肠造瘘和结肠造瘘,主要用于绞窄性肠梗阻、肠坏死合并休克、严重脱水酸中毒、重度腹腔感染和消化道畸形等危重症急腹症患儿,为下一步的治疗做准备。由于造瘘口无括约肌控制,粪便及肠液可随时从瘘口排出,     

Santulli肠造瘘术在小儿早期高位小肠瘘治疗中的应用

目的 探讨Santulli肠造瘘术在小儿早期高位小肠瘘的治疗作用.方法 对6例早期高位小肠瘘患儿行Santulli肠造瘘术.其中男5例,女1例;年龄15 d～5岁.结果 手术距离肠瘘确诊时间为(52.33±19.03)h,瘘口与Treize韧带距离为(17.33±4.68) cm,造口引流量为(760.00±107.56) mL/d.手术探查6例均出现肠管黏连,未出现黏连致密无法分离和分离时肠管破损;5例腹腔内大量粪水、脓液重度污染,1例中度污染.术前并发症:术前手术切口感染6例,完全裂开l例;弥散性腹膜炎6例,全身炎症反应综合征和脓毒血症各3例,肾功能损害2例,肝功能损害1例.术后并发症:术后切口感染1例.术后3d、7d小儿危重评分和血清清蛋白与术前比较显著升高(P均＜0.05);所有病例吻合口愈合无泄漏;术后随访8个月～2年,营养、发育均正常.结论 Santulli肠造瘘术是治疗小儿高位小肠瘘的良好术式,早期实施有利于肠瘘恢复.     

预置切口缝线预防小儿肠造瘘关瘘术后切口感染

切口感染是肠造瘘关瘘术后最常见的并发症,其发生率约41％,可能导致切口全层裂开或切口疝。作者于2008年11月至2010年11月收治90例肠造瘘术后患儿,对其中40例采用预置切口缝线延期打结缝合皮肤,预防切口感染,并与另50例未行预置切口缝线延期打结者进行比较,现报告如下。     

新生儿肠造瘘术39例

2001年1月至2007年10月本院对39例新生儿肛肠疾病患儿实施肠造瘘术,现报告如下。     

新生儿坏死性小肠结肠炎肠造瘘术后造口高流量腹泻的相关因素分析

目的 探讨新生儿坏死性小肠结肠炎(necrotizing enterocolitis, NEC)小肠造瘘术后造口高流量腹泻(high-output stoma, HOS)的相关因素。方法 以2017年7月1日至2021年6月30日广州市妇女儿童医疗中心新生儿外科监护室收治的NEC小肠造瘘术后患儿为研究对象,根据造瘘术后是否出现HOS分为腹泻组及非腹泻组。收集并比较两组患儿一般资料、手术及预后情况,采用单因素分析及多因素Logistic回归分析NEC患儿小肠造瘘术后发生HOS的相关因素。结果 76例NEC患儿中,有25例(32.9%)发生HOS。单因素分析结果显示：出生体重、出生胎龄、手术时矫正胎龄及体重、术前需呼吸支持、分期与分型以及造瘘近端小肠剩余长度是NEC患儿肠造瘘术后发生HOS的相关因素(P<0.05)。Logistic回归分析结果显示：造瘘近端小肠剩余长度(OR=1.220,95%CI:1.108～1.343)是NEC患儿术后发生HOS的独立相关因素(P<0.05)。经造瘘近端小肠剩余长度绘制ROC曲线,曲线下面积为0.926(95%CI:0.849～1.000,...     

小儿肠造瘘术后关瘘时机选择（附58例分析）

<正>肠造瘘术是小儿外科常用的治疗方法之一。与成人相比较,小儿的麻醉手术耐受性较差,故对于手术条件差、病情复杂的患儿,或者是一些先天直肠会阴畸形患儿,都需行暂时性肠造瘘术。对于暂时性肠造瘘术后患儿,因造瘘口并发症较多,护理困难以     

Sedation for peritonsillar abscess drainage in the pediatric emergency department

OBJECTIVE: To evaluate the use of intravenous (IV) sedation in children during peritonsillar abscess (PTA) incision and drainage in the emergency department (ED). DESIGN: Retrospective review of medical records of children with a diagnosis of PTA. SETTING: The ED of a large, urban, academic children's hospital. PATIENTS: Consecutive patients 18 years or younger presenting from April 1995 to November 1998. METHODS: Information was retrieved from a time-based sedation record that included age, sex, ASA classification, time since last liquid or solid, agent and dose, level of sedation (A=alert, V=response to voice, P=purposeful response to pain, U=unresponsive), vital signs, complications, recovery time, and disposition. RESULTS: Forty-two patients had incision and drainage performed with IV sedation in the ED. Mean age was 11.3 +/- 4.3 years (range 4-18 years); 57% were African-American, and 64% were female. Agents used included ketamine plus midazolam (K/M) (n = 36, 86%), morphine plus midazolam (n = 3, 7%), meperidine plus midazolam (n = 2, 5%), and nitrous oxide plus midazolam (n = 1, 2%). No cardiorespiratory complications, including laryngospasm, occurred. Vomiting occurred in 1 patient who received meperidine and midazolam. The deepest level of sedation reached included: 12% A, 64% V, and 24% P. No patient who had an abscess drained in the ED with IV sedation was admitted, and mean recovery time was 81.0 +/- 30.1 minutes. CONCLUSIONS: IV sedation in children for incision and drainage of PTA by skilled personnel in the ED may eliminate the need for admission and surgical drainage in the operating room. K/M was used most frequently, without adverse effect, and all patients were discharged from the ED. Because K/M may result in deep sedation, appropriate personnel and equipment must be present.     

Experience of an interdisciplinary pediatric pain service

This article is a report of our experience with an interdisciplinary pain service in a large tertiary care pediatric hospital. During the first 2 years of operation, we received 869 consultations and referrals from more than 19 hospital divisions. Postoperative pain was the most frequent reason for consultation (56% of patients). Patients with pain related to cancer and sickle cell disease comprised 25% of the consultations. The remaining patients had a wide variety of primary diagnoses and causes of pain. We calculated the time spent by pain service physicians in direct patient care. The majority (63%) of physician time was spent with a small number of patients (17%). Most of these patients had pain that was unrelated to surgery, cancer, or sickle cell disease, and many posed dilemmas in diagnosis and treatment. Physician time was correlated directly to the use of psychologic and physical therapies for the pain, involving multiple team members. This experience supports the demand for an interdisciplinary pain service in a tertiary care children's hospital. A significant amount of physician time is necessary to provide patient care and to maintain a team approach, however, and pediatricians and other health care professionals who aim to implement such services should be cognizant of the time required.     

Experience with the use of piperacillin-tazobactam in pediatric non-renal solid organ transplantation

Bacterial infection remains a major problem after solid organ transplantation (SOT), especially in children. Piperacillin-tazobactam (Pip-Tazo) is a beta-lactam-antibiotic combination with a broad spectrum of activity including gram-positive cocci as well as gram-negative rods, non-fermentative and anaerobic bacteria. The aim of this retrospective study was to critically review our experience with Pip-Tazo as perioperative prophylactic agent in pediatric non-renal SOT. Between 1993 and 2003 Pip-Tazo was used as initial perioperative prophylaxis in 45 pediatric patients who underwent a total of 49 transplants (36 liver-, seven cardiac-, two lung-, and four small bowel-) at our department. Median age of the children was 7.9 (range 0.5-18.1) years. A total of 34 rejection episodes following 27 transplants were diagnosed. During first hospitalization 44 infectious episodes were observed. Bacteria were responsible for 22 episodes including sepsis (n = 10), pneumonia (n = 5), wound infection (n = 4), urinary tract infection (n = 1), and clostridial colitis (n = 2). The isolated organisms were gram-positive cocci (n = 12), gram-negative rods (n = 3), non-fermentative bacilli (n = 4), and anaerobes (n = 3). Ten episodes were caused by Pip-Tazo resistant bacteria. Twenty-one of these infections were observed following antirejection therapy with pulse steroids. At later time points nine infectious episodes were successfully treated with a second course of Pip-Tazo. During follow up, eight patients died. Six deceased perioperatively: five from infection including aspergillosis (n = 4) and Pneumocystis jiroveci pneumonia (n = 1) and cerebrovascular bleeding (n = 1) and two children later on. At present 37 children (82%) are alive with well functioning graft after a median follow up of 39.2 (range 0.6-123.5) months. No severe side effects caused by Pip-Tazo were observed in any of the children. Pip-Tazo may be a suitable single agent for perioperative prophylaxis in pediatric non-renal solid organs recipients, however, a prospective comparative study is needed to make final conclusions.