摘要
肠吻合术与肠造瘘术治疗单纯性肠穿孔的临床疗效
对比研究
研究生：赵翔
攀援导师：陈琦教授
专业：外科学
河南郑州450052
摘要
新生儿肠穿孔是新生儿尤其是低体重早产儿一种并不罕见、致命性的疾病，是新生儿胃肠道死亡的重要原因，是早产儿死亡的主要原因之一。本病往往由多种病因所致，多由新生儿坏死性小肠结肠炎所致的肠坏死或先天性肛门闭锁、先天性巨结肠等机械性肠梗阻引起，而新生儿单纯性肠穿孔作为其罕见发病
原因，在临床上逐渐引起重视。新生儿单纯性肠穿孔为一种无原发病变、无外伤史的肠穿孔，因发病机制尚不明确，其也被称为自发性、局灶性或特发性肠穿孔。以前一直把新生儿单纯性肠穿孔看作是新生儿坏死性小肠结肠炎的早期表现或一种特殊类型，到20世纪80年代后才被看做成一种独立发生的疾病，得到广泛的关注。新生儿单纯性肠穿孔，起病急、发展快、早期缺乏明显的临床表现、影像诊断上并无明显特异性、病死率高，因而是严重威胁患儿生命的临床问题。文献报道，新生儿单纯性肠穿孔好发于极低出生体重儿，穿孔率约3%～6%，约83%发生于回盲部及结肠脾曲，可能与该部位的特殊解剖关系有关。也有国外报道称，肠蠕动功能障碍、败血症、血液低灌注、地塞米松、吲哚美辛等药物应用、先天性肠发育缺陷等因素是新生儿单纯性肠穿孔发病高危因素。尽管新生儿单纯性肠穿孔的发病原因及机制有多种说法，但目前仍不清楚。手术是治愈新生儿单纯性肠穿孔的唯一手段，许多文章报道肠吻合术与肠造瘘术可作为其手
术方式，然而并没有两种手术方式进行对比的报道。本文选取23
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第三附属医院普外科行肠造瘘术与肠吻合术的单纯性肠穿孔新生儿病例，比较
摘要
两种手术方式的临床疗效，选取更优的手术方式。
目的
单纯性肠穿孔的治疗对新生儿外科构成严重的挑战。肠吻合术和肠造瘘术一直以来被认为是其治疗的经典手术方式，然而很少有对两手术方式进行比较的报道。我们的目的是分析对比肠吻合术与肠造瘘术两种手术，选取更加适合单纯性肠穿孔患儿的治疗方式。
临床资料和方法
2014年06月至2016年06月收治的23例单纯性肠穿孔患儿纳入研究，分为肠造瘘术实验组与肠吻合术对照组。观察比较两组在腹膜炎，手术时间，术中出血量，术后住院天数，胃肠道功能恢复时间，近期远期术后并发症等方面有无差异。所得数据用SPSS21．0软件进行统计学分析，计数资料采用X2检验；计量资料采用t检验。以P＜0.05位差异有统计学意义。
结果
1.实验组与对照组两组患儿在胎龄、出生体重、入院年龄等一般临床资料差异无统计学意义（P＞0.05）。
2.与肠吻合术组相比，肠造瘘术组术中的出血量明显降低（P=0.009）；而手术时间，腹膜炎方面，两者间的差异无统计学意义（P=0.682，P=0.643）。
3.在术后近期疗效上，肠造瘘术组术后肠功能恢复时间以及术后住院天数明显缩短（P=0.000，P=0.001）；而在切口感染差异无统计学意义（P=0.400）。实打实是什么意思
4.在术后远期疗效上，肠造瘘术组术后肠梗阻，术后死亡，二次手术，发生新生儿小肠结肠炎明显低于肠吻合术组（P=0.029，P=0.019，P=0.009，P=0.048）。
结论
1.肠造瘘术与肠吻合术相比，能有效减少术中出血量、缩短术后胃肠道功能恢复时间以及术后住院天数、降低术后肠梗阻，术后死亡等，值得在临床上推
摘要
广运用。
2.肠造瘘术可以缩短住院天数，减少术后死亡率，从而减轻患者家属精神负担，值得在临床上推广。
关键词：单纯性肠穿孔肠造瘘术肠吻合术新生儿
Abstract
Comparison Rearch of Clinical Effect Betwwen Intestinal Anastomosis and Ileostomy In the Treatment of Isolated
韩信铭文>林少宫Intestinal Perforation
好句摘抄短一点
Postgraduate:Xiang Zhao
Supervisor:Prof:Qi Chen
Major:Surgery
The Third Affiliated Hospital of Zhengzhou University
Zhengzhou,Henan,450052
Abstract
Neonatal intestinal perforation is not a rare but a fatal dia in neonates, especially low birth weight premature infants.This dia is often caud by many factors,such as neonatal necrotizing
enterocolitis,congenital anal atresia,congenital megacolon etc.Isolated intestinal perforation is a rare cau of the neonatal intestinal perforation.The simple perforation of the intestine is a kind of intestinal perforation with no primary lesion and no history of trauma.The pathogenesis is still not clear. Isolated intestinal perforation is en as early manifestations of neonatal necrotizing enterocolitis or a special type and it is en as a independent occurrence of dia in the1980s.Isolated intestinal perforation has rapid development,lack of early clinical manifestations and imaging diagnosis is not obvious,so it is a rious threat to children with the clinical problems of life.It is reported that the simple perforation of the newborn is very low in the birth weight infants and the perforation rate is about 3%~6%,in addition,about83%occurs in the ileocecal region and the spleen flexure of the colon.Foreign literature reports that bowel dysfunction,pticemia,blood hypoperfusion,dexamethasone,indomethacin,application of congenital intestinal developmental defects and other factors are high risk factors of neonatal herpes intestinal perforation.Although the etiology and mechanism of neonatal simple
预备党员需要交党费吗Abstract
intestinal perforation have many kinds of views,it is still unclear.Surgery is the only way to cure the simple perforation of the intestine.Many articles have reported that intestinal anastomosis and colost
omy can be ud as the operative method.This paper lects23cas in the Department of general surgery,the Third Affiliated Hospital of Zhengzhou University underwent colostomy and intestinal anastomosis simple intestinal perforation in neonates,to compare the clinical efficacy of two surgical methods,lection of surgical methods better.
Objective
Treatment of isolated intestinal perforation pos a rious challenge to neonatal surgery.Intestinal anastomosis and colostomy have long been considered as the classic surgical treatment of the dia,but few reports have been made on the two surgical procedures.Our purpo is to analyze and compare two kinds of intestinal anastomosis and intestinal fistula surgery and choo a more suitable way for isolated intestinal perforation in the treatment of children.
肌肉耐力Materials and method
According to the inclusion criteria,23cas of isolated intestinal perforation in the Department of general surgery of the First Affiliated Hospital of Zhengzhou University from2014to2016were included in the study.The patients were divided into the experimental group and the control group.The two groups were compared between peritonitis,operation time,intraoperative blood loss,p
ostoperative hospital stay,recovery time of gastrointestinal function.The data was analyzed by SPSS21.0 software,and the data were tested by X2test.The data were analyzed by t test.The difference was statistically significant with P<0.05.
Results
1.There was no significant difference between the experimental group and the control group in the clinical data such as gestational age,birth weight,age at
