頁籤選單縮合
題 名 | Management of Gastroschisis Complicated with Jejunal Atresia and Colon Stenosis=腹裂畸形合併空腸閉鎖及大腸狹窄之手術治療 |
---|---|
作 者 | 陳厚全; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 31:5 民87.09-10 |
頁 次 | 頁325-328 |
分類號 | 417.6244 |
關鍵詞 | 腹裂畸形; 空腸閉鎖; 大腸狹窄; Gastroschisis; Jejunal atresia; Colon stenosis; |
語 文 | 英文(English) |
中文摘要 | 腹裂畸形合併小腸閉鎖症在外科治療方面有各種不同之處理方式。根據文獻報告大略可分為三種方式:(一)於關閉腹裂畸形時同時施行小腸閉鎖直接吻合術。(二)於關閉腹裂時施行小腸閉鎖近端造�眾N,俟適當時機再施行小腸吻合手術。(三)於關閉腹裂時不另施行小腸部份之手術,採以胃管減壓,於適當時機再行小腸吻合術。上述之三種方法以何者為最好仍然存有不同之意見。本文報告一男嬰因腹裂畸形合併空腸閉鎖及乙狀結腸狹窄,於出生後隨即接受腹裂畸形關閉手術,同時施以空腸造�眾N。經空腸造廔減壓及全靜脈營養術後,於出生第21天再施行第二次手術,施以空腸吻合術及乙狀結腸狹窄處切除併行斷端吻合術。病人於出生後第53天出院,並持續於門診追蹤五年,發育及營養狀況均正常。我們認為以空腸造廔可以達到理想的減壓效果,可以使極度脹大的空腸近端縮小到容易施行吻合術。在第二次手術時(本病例為間隔三週),原先纏結在一起之小腸已經恢復成近乎正常小腸之外觀。此時可以仔細的查看腸道是否有其他部位閉鎖或狹窄。本例病即是於第二次手術時很清楚的發現原先懷疑乙狀結腸狹窄之處確實存在,而能於吻合小腸閉鎖時同時適當的處理乙狀結腸狹窄。 |
英文摘要 | Gastroschisis with concomitant intestinal atresia is a complex problem. Atresic intestine has been treated by primary anastomosis, initial exteriorization, or by placing the atretic bowel into the abdomen with a later anastomosis. However, controversy still exists over the best method of treatment. A 2670 gm baby boy with gastroschisis complicated by jejunal atresia and stenosis of the sigmoid colon received jejunostomy and primary closure of the abdominal wall defect as an initial procedure. On his 21st day of life,jejunal anastomosis and resection of the stenotic segment of colon with anastomosis was performed. The baby was discharged a month later with weight gain, and is doing well at 5 years of age. Our experience demonstrates that an initial exteriorization of the extremely dilated proximal intestine can lead to thorough decompression and greatly reduce the caliber of proximal bowel to facilitate a later anastomosis. During later exploration, the previously matted mass of intestine appeared nearly normal; therefore, the distal colon stenosis was more obvious and could be managed appropriately. |
本系統中英文摘要資訊取自各篇刊載內容。