手术治疗肠套叠并肠切除78例临床研究

目的探讨手术治疗肠套叠并肠切除一期吻合术的可行性及近远期效果。方法于2000年1月至2008年6月收治的78例肠套叠手术复位后合并肠坏死、肠穿孔者72例和继发性肠套叠6例，行肠切除一期端端吻合术，并对其近远期效果进行临床分析。结果78例中合并肠坏死而无穿孔者48例，合并肠穿孔者30例，合并梅克尔憩室者3例，合并过敏性紫癜致肠壁血肿者2例，合并肠壁淋巴瘤者1例。结肠切除结肠端端吻合26例，回肠切除回肠端端吻合38例，回盲部及部分结肠切除回结端端吻合14例。78例患儿术后恢复良好，76例伤口一期愈合，无肠瘘、肠狭窄及死亡病例。术后随访3个月-9年，其中12例较术前有明显稀便情况，1例术后5d刀口感染经换药再次缝合后痊愈，1例术后6d合并肺炎及切口处肌层断开出现腹壁疝，1例术后6个月发生粘连性肠梗阻经再次手术松解粘连带而痊愈。结论对于肠套叠合并肠壁血运障碍或有器质性病变者可行肠切除一期吻合术，一般不需要考虑肠造瘘或肠管旷置，近远期无明显并发症。

Clinical study on anastomosis by first intention of indigitation excision of 78 cases

Objective To explore the feasibility and long and short term effect of the first stage anastomosis of indigitation excision of 78 cases. Methods After indigitation excision operation, 72 children among 78 patients accepted from January 2000 to June 2008 suffered from intercurrent intestines putrescence and intestinal perforation, while the left 6 patients suffered from secondary affection. They were treated with first stage anastomosis of end to end intestinal excision. Clinical analysis was made for the long and short term effects. Results Forty -eight children among total 78 cases suffered from intercurrent intestines putrescence without intestinal perforation, 30 cases from intestinal perforation ,3 cases from Meckel＇s diverticulum,2 cases from allergic purpura incurred intestinal wall hematoma, 1 cases from intestinal wall lymphoma. 26 children received operation of colon excision and end to end anastomosis ,38 received ileum or part excision and ileum end to end anastomosis, 14 received cecum and part of colon excision and end to end anastomosis. All 78 patients recovered very well after operation, among which 76 cases healed by first intention, and there were no intesninal fistula,intesninal stricture and dying cases happened. Through random visits to the patients three months to nine years after the operation, we found that： 12 of them had evident loose bowel movement compared with before; 1 case was treated with another suture because the cut was infected five days after the operation ; 1 case happened with muscle break and ventral hernia six days after the operation;1 case received another operatign for loosening because of adhesive intestinal obstruction six months after the operation and recovered very well. Conclusions Patients with severe indigitation and intercurrent intestinal wall blood movement obstruction or organic pathological changes can be treated with intesninal excision for anastomosis by first intention without regarding enterostomy or exclusion of intesninal fistula. In a long or sho