论文部分内容阅读
女婴,9个月,在外院误诊为菌痢治疗3d后病情恶化急转本院。入院情况,患儿反应极差,哭声低微,皮肤发花,四肢冷,腹胀明显,WBC18×10~9/L, N0.9;钡灌肠造影发现钡剂在乙状结肠与降结肠交界处形成杯影。加压复位失败后,急行剖腹探查。探查所见;套叠是回结结型,头部达降结肠下段,手法强行复位后,见右半结肠壁薄如蝉翼,横、降结肠上段血运不佳,回肠末端15cm是紫黑色,温盐水热敷20min后,横、降结肠血运转佳,回肠末端色泽无改变。当即切除右半结肠及部分凹肠,行回一横结肠端端吻合。术后加强抗休克措施,术后第3d进奶。第4d患儿体温突然上升达39℃,腹胀明显,呼吸急促,腹平片示巨大气液面占了半个腹腔。疑为吻合口漏,再次剖腹。探查见腹腔内为大量肠内容物,肠壁充血水肿,原吻合门无裂开,距吻合口远端10、15和20cm各见0.5~1.0cm穿孔,另有3处肠壁呈直径0.5~0.7cm紫黑色坏死区。当即行左半结肠切除,回一乙状结肠端端吻合。腹腔以大量盐水冲洗后,右下腹单管引流,关腹。术后联合抗感染、抗休克及液体支持疗法,并给小量多次输血。术后一周进奶,切口Ⅰ期愈合,2周后出院,3个月后随访,患儿情况良好,每日大便1~2次,1年后随访,患儿发育正常。
Baby girl, 9 months, misdiagnosed as bacillary dysentery in the outer court 3 days after the condition deteriorated rapidly hospital. Admission, children with poor response, crying low, the skin of flowers, cold limbs, abdominal distension, WBC18 × 10 ~ 9 / L, N0.9; barium enema found barium in the sigmoid and descending colon junction cup shadow. After the failure of pressure reduction, emergency laparotomy. Exploration found; nesting is the knot knot type, the head reached the lower descending colon, after the forced reset method, see the right half of the colon wall as thin as onion skin, transverse and descending colon, upper colon poor blood supply, the terminal ileum 15cm is purple black , Warm brine 20min after heat, transverse, descending colon blood circulation is good, no change in the color of the terminal ileum. Immediately removed the right colon and part of the bowel, back to a transverse colon anastomosis. Postoperative anti-shock measures to strengthen, after the first 3d into the milk. 4d sudden increase in temperature in children up to 39 ℃, abdominal distension, shortness of breath, abdominal plain film showed a huge gas-liquid surface accounted for half a celiac. Suspected anastomotic leakage, cesarean section again. Exploration to see the abdominal cavity for a large amount of intestinal contents, congestion and edema of the intestine, the original anastomosis door no split away from the distal anastomosis 10,15 and 20cm of each see 0.5 ~ 1.0cm perforation, and the other three were 0.5 ~ 0.7cm purple black necrosis area. Immediate left colon resection, back to a sigmoid colon anastomosis. Abdominal cavity flush with a large amount of saline, the right lower abdomen single-tube drainage, abdominal closure. Anti-infection after surgery, anti-shock and fluid support therapy, and to a small number of multiple transfusions. One week after operation, the wounds healed in the first stage, discharged after 2 weeks, and were followed up after 3 months. The children were in good condition, with 1 ~ 2 stools per day and follow-up after 1 year. The children developed normally.