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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%)vs 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%)vs 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%)vs 4例(6.4%)尿液白细胞数目异常,数目为(124.42±106.33)vs(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(t=0.066,P>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。
Objective To investigate and summarize the advantages and disadvantages of transverse colon 袢 袢 ostomy in the treatment of children with congenital anorectal malformations. Methods A retrospective analysis of 62 cases of congenital anorectal malformation in children with preventive transverse colon 袢 ostomy surgery after the clinical manifestations and related important auxiliary examinations; comprehensive analysis of the ostomy for children with congenital anorectal malformations throughout the course of treatment Influence, and analyze the reason. Results (1) The preoperative blood routine results of the second and third phases in 62 children showed mild anemia in 21 patients (33.9%) vs 22 patients (35.5%), respectively. No severe or very severe anemia occurred. (2) Mild hypoalbuminemia occurred in 5 cases (8.1%) and 1 case (1.6%) in 62 cases of stage II and III respectively. (3) Peripheral blood electrolytes examination in the second phase of 62 cases showed mild electrolyte disturbance in 7 cases (11.3%), of which 6 cases recovered completely before the third phase without hyperchloremia. (4) The urinary routine results of 62 children showed that the number of urine leukocyte was (124.42 ± 106.33) vs (74.75) in 19 cases (30.7%) vs 4 cases (6.4% ± 52.89) / μL, only 1 case showed obvious symptoms of urinary tract infection. (5) 57 cases of children in the second preoperative transverse colon ostomy can identify the location of abnormal fistula, exactly the same as found in the operation (100%), and the angiography measured the rectum blind with the anal crypt (34.63 ± 6.01) mm, which was not significantly different from the actual measured distance (37.33 ± 6.17) mm (t = 0.066, P> 0.05). (6) 62 cases of children with stoma follow-up observation showed no serious bowel retraction and prolapse. Conclusion Transverse colonic 袢 ostomy is an effective and safe method for the treatment of congenital anorectal malformation in children. It has the advantages of simple operation, less complications, and no serious adverse effects on nutritional status and growth of children.