肠折叠术在肠闭锁手术中的应用

目的 评价肠折叠术在肠闭锁手术中的应用效果.方法 回顾分析2005年4月至2009年4月南京医科大学附属南京儿童医院收治的68例肠闭锁患儿术前、术中和术后恢复过程的临床资料,比较手术方法、胎龄、出生体重、伴发疾病、手术年龄和时间、住院时间、全静脉营养持续时间、肠功能恢复时间(术后经口喂养时间、术后经口喂养达40ml/3 h的时间)、生长发育以及是否需再手术等方面的差异.结果 根据手术方法将患儿分为二组,38例在切除闭锁盲端肠吻合基础上加肠折叠术(折叠组),30例行扩张段斜行切除肠成形术(对照组);二组在胎龄、出生体重、伴发疾病、手术年龄上差异无统计学意义;折叠组手术时间(1.21±0.24)h、住院时间(12.2±2.5)d比对照组(1.77±0.31)h、(17.3±3.2)d显著减少(P＜0.05);折叠组术后经口喂养时间、术后经口喂养达40ml/3 h的时间和全静脉营养持续时间分别是(8±2.3)d、(13.1±1.9)d、(8.3±1.8)d,均比对照组(12.9±1.7)d、(18.7±1.1)d、(13.6±2.5)d显著缩短(P＜0.05);术后半年内折叠组有1例因粘连性肠梗阻需再次手术,对照组共有6例术后半年内再次手术,其中术后功能性肠梗阻3例、吻合口漏2例、粘连性肠梗阻1例,比折叠组显著增加.术后平均随访时间为2.7年(6个月至5年),二组生长发育达到正常标准,差异无统计学意义.结论 肠闭锁手术时在肠吻合基础上加肠折叠术,方法简单,创伤小,并发症少,有助于保留肠管吸收面积和促进肠功能恢复,可以作为预防肠闭锁扩张肠管功能性梗阻的一种有效选择方法.

Abstract：

Objective To evaluate the efficacy of bowel plication as a part the surgical treatment of intestinal atresia (IA) in childrea Methods Between April 2005 and April 2009,68 neonates with IA underwent surgical treatment in this center. According to the surgical procedures the patients underwent, the 68 neonates were divided into bowel plication group and control group. The 38 children underwent bowel plication after atretic segments resection and primary anastomosis. The 30 children of the control group underwent tapering enteroplasty after atretic segments resection. Data including operation procedures,ages,birth weight,concomitant diseases,age at surgery, length of hospital stay, length of total parenteral nutrition (TPN),postoperative intestinal function recovery (the time of the first oral feeding and the oral feeding volume reached 40 ml/kg/3h),growth and development,complications and reoperations were retrospectively analyzed. Results No differences of ages, birth weight, age at operation, and concomitant diseases were found between the two groups. The time of operation and hospital stay of the bowel plication group were significantly shorter than those of the control group [(1.21±0.24)h,(12.2±2.5)d vs. (1. 77 ± 0. 31)h, (17. 3 ± 3. 2)d,P＜0. 010]. The time of the first oral feeding, the time when oral feeding volume reached 40 ml/kg/3h,and TPN length of the bowel plication group were also shorter than those of control group [(8 ± 2. 3)d, (13. 1 ± 1. 9)d, (8. 3 ± 1.8)d vs (12. 9 ±1. 7)d,(18. 7 ± 1. l)d,(13. 6 ± 2. 5)d,P＜0. 05]. In the bowel plication group, 1 (2. 6%) underwent reoperation for adhesive intestinal obstruction half a year after the initial surgery. However,in the control group,6 (20%) included 3 underwent reoperation for intestinal obstruction,2 for anastomotic leakage and 1 for adhesive intestinal obstruction. The patients were followed up for an average period of 2. 7 years (6 months-5 years). All infants thrived. Conclusions The additional bowel plication after atretic segment resection and primary anastomosis improves the clinical outcomes for children with intestinal atresia.     

生长抑素对缺氧缺血性脑病肠损伤的治疗

Objective To explore the therapeutical effect of somatostatin(SST) on the damaged bowel barrier of 7-day-old SD rats with hypoxic-ischemic encephalopathy(HIE). Methods Total 7-day-old SD rats were randomly divided into untreated control group(n=6), sham-operated group(n = 6), HIE model group(n = 8) and SST-treated group(n = 8). After 6 hours of operation, abdominal aorta blood of the rats was collected to measure the level of D-lactic acid, the ileum was taken for pathological analysis and immunohistochemistry staining of SP. Results The level of D-lactic acid in HIE model group was obviously increased[(10.30 ± 1.70)mg/L], and there were significant differences compared to untreated control group, sham-operated group as well as SST-treated group respectively(P < 0.05, respectively). The cillia of ileum became widen and shorten, and the number of it decreased. At the same time, in the stratum mucosa and the neurofibrillary tangle, the expression of SP was increased (average optical density: 12.67 ± 5.46), and there were significant differences compared to untreated control group, sham-operated group as well as SST-treated group raspectively (P < 0.05,respectively).Compared with HIE model group,the level of D-lactic aeid decreased obviously[(7.35 ± 1.55) mg/L] in SST-treated group,and there were no differences compared to untreated control group and sham-operated group respectively. The intestinal villi became thinner and higher in the SST-treated group, even the number increased. Besides that, the expression of SP decreased(average optical density: 0.73 ± 0.09), and there were no differences compared to untreated control group and sham-operated group respectively. Conclusion The therapeutical effect of SST on the bowel barrier damage of 7-day-old SD rats with HIE is clear.     

生长抑素对缺氧缺血性脑病肠损伤的治疗

Objective To explore the therapeutical effect of somatostatin(SST) on the damaged bowel barrier of 7-day-old SD rats with hypoxic-ischemic encephalopathy(HIE). Methods Total 7-day-old SD rats were randomly divided into untreated control group(n=6), sham-operated group(n = 6), HIE model group(n = 8) and SST-treated group(n = 8). After 6 hours of operation, abdominal aorta blood of the rats was collected to measure the level of D-lactic acid, the ileum was taken for pathological analysis and immunohistochemistry staining of SP. Results The level of D-lactic acid in HIE model group was obviously increased[(10.30 ± 1.70)mg/L], and there were significant differences compared to untreated control group, sham-operated group as well as SST-treated group respectively(P < 0.05, respectively). The cillia of ileum became widen and shorten, and the number of it decreased. At the same time, in the stratum mucosa and the neurofibrillary tangle, the expression of SP was increased (average optical density: 12.67 ± 5.46), and there were significant differences compared to untreated control group, sham-operated group as well as SST-treated group raspectively (P < 0.05,respectively).Compared with HIE model group,the level of D-lactic aeid decreased obviously[(7.35 ± 1.55) mg/L] in SST-treated group,and there were no differences compared to untreated control group and sham-operated group respectively. The intestinal villi became thinner and higher in the SST-treated group, even the number increased. Besides that, the expression of SP decreased(average optical density: 0.73 ± 0.09), and there were no differences compared to untreated control group and sham-operated group respectively. Conclusion The therapeutical effect of SST on the bowel barrier damage of 7-day-old SD rats with HIE is clear.     

四种干预措施对早产儿喂养不耐受的疗效比较

Objective To compare the impact of four kinds of interventions (intermittent enteral feeding, continuous enteral feeding, motilium, low-dose erythromycin) on feeding intolerance in preterm infants. Methods 160 cases preterm infants with feeding intolerance (28～32 weeks of gestational age) were divided into 4 groups :intermittent enteral feeding ,continuous enteral feeding,oral motilium and intravenous infusion of low-dose erythromycin treatment group. We recorded the amount of each feeding, the disappearance time of vomiting,abdominal distension,gastric retention,and the time of total enteral nutrition feeding. We observed the characteristics of meconinm excretion. We recorded the daily body weight to calculate the growth rate,and observed the time period of their body weight return to its birth weight. Results Meconium discharge time and total enteral nutrition feeding time of the intermittent feeding group were (3.6±1.6) days and ( 15.8±5.6) days,those of continuous feeding group were (5.2±2. 0) days and( 17. 1±4. 4) days,showing significant difference between these two groups ( P < 0. 05 ). The rate of improving feeding intolerance in the 4 groups were 37. 5% ,32. 5% ,80. 0% and 87.5% ,and there was significant difference between the furst two groups and the after two groups ( P < 0. 05 ). The disappearance time of vomiting in the four groups were(4. 33±2. 49) days, (4. 85±2. 14) days, (2.97±1.27) days and(2. 16±1.65) days,showing significant difference between the first two groups and the following two groups( P <0.05). The disappearance time of abdominal distension in the low-dose erythromycin groups was (2. 47±1.34) days, and that in the motilium group was (3. 59±1.35 ) days, showing significant difference between the two groups ( P <0. 05 ). Conclusion Both motilium and low-dose erythromycin can improve feeding intolerance in premature infants,which is recommendable for clinical application. The low-dose erythromycin is the first choice of the four groups,followed by the motiliumand intermittent enteral feeding, and the last one is continuous enteral feeding.     

四种干预措施对早产儿喂养不耐受的疗效比较

Objective To compare the impact of four kinds of interventions (intermittent enteral feeding, continuous enteral feeding, motilium, low-dose erythromycin) on feeding intolerance in preterm infants. Methods 160 cases preterm infants with feeding intolerance (28～32 weeks of gestational age) were divided into 4 groups :intermittent enteral feeding ,continuous enteral feeding,oral motilium and intravenous infusion of low-dose erythromycin treatment group. We recorded the amount of each feeding, the disappearance time of vomiting,abdominal distension,gastric retention,and the time of total enteral nutrition feeding. We observed the characteristics of meconinm excretion. We recorded the daily body weight to calculate the growth rate,and observed the time period of their body weight return to its birth weight. Results Meconium discharge time and total enteral nutrition feeding time of the intermittent feeding group were (3.6±1.6) days and ( 15.8±5.6) days,those of continuous feeding group were (5.2±2. 0) days and( 17. 1±4. 4) days,showing significant difference between these two groups ( P < 0. 05 ). The rate of improving feeding intolerance in the 4 groups were 37. 5% ,32. 5% ,80. 0% and 87.5% ,and there was significant difference between the furst two groups and the after two groups ( P < 0. 05 ). The disappearance time of vomiting in the four groups were(4. 33±2. 49) days, (4. 85±2. 14) days, (2.97±1.27) days and(2. 16±1.65) days,showing significant difference between the first two groups and the following two groups( P <0.05). The disappearance time of abdominal distension in the low-dose erythromycin groups was (2. 47±1.34) days, and that in the motilium group was (3. 59±1.35 ) days, showing significant difference between the two groups ( P <0. 05 ). Conclusion Both motilium and low-dose erythromycin can improve feeding intolerance in premature infants,which is recommendable for clinical application. The low-dose erythromycin is the first choice of the four groups,followed by the motiliumand intermittent enteral feeding, and the last one is continuous enteral feeding.     

低分子肝素钙治疗过敏性紫癜及预防肾损害的作用

Objective To investigate the curative effect of low molecular heparin calcium on Henoch-Schoenlein purpura(HSP) and the preventive effect on Henoch-schonlein purpura nephritis.Methods One hundred and three patients with HSP were enrolled in the study and divided randomly into two groups,heparin group(57 cases) and control group(46 cases).Heparin group received low molecular heparin calcisymptom remission time,the incidence of recurrent skin rash were recorded.The contents of D-dipolymer and the three indicators of early renal damage were detected before and after the treatment.Results The remission times of purpura,joint pain and abdominal pain in heparin group[(15.23±3.14) d,(6.80±1.96) d and(6.68±3.42) d]were significantly shorter than those of control group[(17.11±4.79) d,(8.30±2.67)d,(8.59±4.09) d](P ＜0.05).The incidence of recurrent skin rash in heparin group(14.6%) was significantly lower than that of control group(39.1%)(P＜0.01).Compared to control group,the positive rate of D-dipolymer in heparin group was higher(15.8% vs 37.0%),and the urine levels of mALB,β2-MG and NAG were significantly decreased[(12.22±3.92) mg/L,(5.35±0.51) mg/L,(8.12±.65) U/L vs (14.15±5.17) mg/L,(6.54±2.67) mg/L,(10.04±2.60) U/L]during 3 months after treatment(P＜0.01,P ＜0.05).Conclusion Low molecular heparin can shorten the course of HSP and prevent the development of Henoch-Schonlein purpura nephritis.     

低分子肝素钙治疗过敏性紫癜及预防肾损害的作用

Objective To investigate the curative effect of low molecular heparin calcium on Henoch-Schoenlein purpura(HSP) and the preventive effect on Henoch-schonlein purpura nephritis.Methods One hundred and three patients with HSP were enrolled in the study and divided randomly into two groups,heparin group(57 cases) and control group(46 cases).Heparin group received low molecular heparin calcisymptom remission time,the incidence of recurrent skin rash were recorded.The contents of D-dipolymer and the three indicators of early renal damage were detected before and after the treatment.Results The remission times of purpura,joint pain and abdominal pain in heparin group[(15.23±3.14) d,(6.80±1.96) d and(6.68±3.42) d]were significantly shorter than those of control group[(17.11±4.79) d,(8.30±2.67)d,(8.59±4.09) d](P ＜0.05).The incidence of recurrent skin rash in heparin group(14.6%) was significantly lower than that of control group(39.1%)(P＜0.01).Compared to control group,the positive rate of D-dipolymer in heparin group was higher(15.8% vs 37.0%),and the urine levels of mALB,β2-MG and NAG were significantly decreased[(12.22±3.92) mg/L,(5.35±0.51) mg/L,(8.12±.65) U/L vs (14.15±5.17) mg/L,(6.54±2.67) mg/L,(10.04±2.60) U/L]during 3 months after treatment(P＜0.01,P ＜0.05).Conclusion Low molecular heparin can shorten the course of HSP and prevent the development of Henoch-Schonlein purpura nephritis.     

低分子肝素钙治疗过敏性紫癜及预防肾损害的作用

Objective To investigate the curative effect of low molecular heparin calcium on Henoch-Schoenlein purpura(HSP) and the preventive effect on Henoch-schonlein purpura nephritis.Methods One hundred and three patients with HSP were enrolled in the study and divided randomly into two groups,heparin group(57 cases) and control group(46 cases).Heparin group received low molecular heparin calcisymptom remission time,the incidence of recurrent skin rash were recorded.The contents of D-dipolymer and the three indicators of early renal damage were detected before and after the treatment.Results The remission times of purpura,joint pain and abdominal pain in heparin group[(15.23±3.14) d,(6.80±1.96) d and(6.68±3.42) d]were significantly shorter than those of control group[(17.11±4.79) d,(8.30±2.67)d,(8.59±4.09) d](P ＜0.05).The incidence of recurrent skin rash in heparin group(14.6%) was significantly lower than that of control group(39.1%)(P＜0.01).Compared to control group,the positive rate of D-dipolymer in heparin group was higher(15.8% vs 37.0%),and the urine levels of mALB,β2-MG and NAG were significantly decreased[(12.22±3.92) mg/L,(5.35±0.51) mg/L,(8.12±.65) U/L vs (14.15±5.17) mg/L,(6.54±2.67) mg/L,(10.04±2.60) U/L]during 3 months after treatment(P＜0.01,P ＜0.05).Conclusion Low molecular heparin can shorten the course of HSP and prevent the development of Henoch-Schonlein purpura nephritis.     

低分子肝素钙治疗过敏性紫癜及预防肾损害的作用

Objective To investigate the curative effect of low molecular heparin calcium on Henoch-Schoenlein purpura(HSP) and the preventive effect on Henoch-schonlein purpura nephritis.Methods One hundred and three patients with HSP were enrolled in the study and divided randomly into two groups,heparin group(57 cases) and control group(46 cases).Heparin group received low molecular heparin calcisymptom remission time,the incidence of recurrent skin rash were recorded.The contents of D-dipolymer and the three indicators of early renal damage were detected before and after the treatment.Results The remission times of purpura,joint pain and abdominal pain in heparin group[(15.23±3.14) d,(6.80±1.96) d and(6.68±3.42) d]were significantly shorter than those of control group[(17.11±4.79) d,(8.30±2.67)d,(8.59±4.09) d](P ＜0.05).The incidence of recurrent skin rash in heparin group(14.6%) was significantly lower than that of control group(39.1%)(P＜0.01).Compared to control group,the positive rate of D-dipolymer in heparin group was higher(15.8% vs 37.0%),and the urine levels of mALB,β2-MG and NAG were significantly decreased[(12.22±3.92) mg/L,(5.35±0.51) mg/L,(8.12±.65) U/L vs (14.15±5.17) mg/L,(6.54±2.67) mg/L,(10.04±2.60) U/L]during 3 months after treatment(P＜0.01,P ＜0.05).Conclusion Low molecular heparin can shorten the course of HSP and prevent the development of Henoch-Schonlein purpura nephritis.     

低分子肝素钙治疗过敏性紫癜及预防肾损害的作用

Objective To investigate the curative effect of low molecular heparin calcium on Henoch-Schoenlein purpura(HSP) and the preventive effect on Henoch-schonlein purpura nephritis.Methods One hundred and three patients with HSP were enrolled in the study and divided randomly into two groups,heparin group(57 cases) and control group(46 cases).Heparin group received low molecular heparin calcisymptom remission time,the incidence of recurrent skin rash were recorded.The contents of D-dipolymer and the three indicators of early renal damage were detected before and after the treatment.Results The remission times of purpura,joint pain and abdominal pain in heparin group[(15.23±3.14) d,(6.80±1.96) d and(6.68±3.42) d]were significantly shorter than those of control group[(17.11±4.79) d,(8.30±2.67)d,(8.59±4.09) d](P ＜0.05).The incidence of recurrent skin rash in heparin group(14.6%) was significantly lower than that of control group(39.1%)(P＜0.01).Compared to control group,the positive rate of D-dipolymer in heparin group was higher(15.8% vs 37.0%),and the urine levels of mALB,β2-MG and NAG were significantly decreased[(12.22±3.92) mg/L,(5.35±0.51) mg/L,(8.12±.65) U/L vs (14.15±5.17) mg/L,(6.54±2.67) mg/L,(10.04±2.60) U/L]during 3 months after treatment(P＜0.01,P ＜0.05).Conclusion Low molecular heparin can shorten the course of HSP and prevent the development of Henoch-Schonlein purpura nephritis.