Analysis Of The Curative Effect Of Internal Stenting With Anterograde And Retrograde In The Treatment Of Adhesive Small Bowel Obstruction In Children

ObjectiveTo analyze the curative effect of anterograde and retrograde small bowel intubation arrangement in the treatment of adhesive small intestinal obstruction in infants and young children,to provide reliable clinical basis and treatment methods for the treatment of infant adhesive small bowel obstruction.MethodsThe clinical data of 126 children with adhesive small bowel obstruction treated by intestinal intubation in the Third Affiliated Hospital of Zhengzhou University from January 2012 to December 2015 were retrospectively analyzed.The children who underwent antegrade intestinal intubation were divided into group A,and the children who underwent retrograde intestinal intubation were divided into group B.the postoperative conditions,postoperative hemogram indexes,catheter-related complications and abdominal follow-up after discharge of the two groups were statistically analyzed.Statistical methods: all data were analyzed by SPSS17.0statistical software,the measurement data were described by median and upper and lower quartile: m(P25,p75),Wilcoxon rank sum test(Z value),with P < 0.05 as the difference was statistically significant.Follow up observation of two groups of patients after discharge follow-up abdominal conditions,postoperative catheterrelated complications data,using N /%,using chi square test,P < 0.05 as the difference was statistically significant.Results1.126 cases of children underwent small intestinal intubation,71 cases in group A and 55 cases in group B.the patients were followed up for(77.6 ± 12.2)months,3 cases(2.4%)died in hospital,8 cases(6.3%)lost follow-up,11 cases(8.9%)had catheter-related complications and 5 cases(4.3%)had obstruction recurrence.2.Two cases died in group A,both premature and low birth weight infants.Because of neonatal necrotizing enterocolitis,they were operated on 15 and 21 days after birth respectively.They could not be separated from the ventilator support after operation,and finally their family members gave up treatment and died of respiratory failure.In group A,5 cases were lost to follow-up,and 10 cases(14.5%)had postoperative complications related to catheterization,including 5 cases of difficult extubation,which were treated with multiple extubation;5 cases of small intestinal intussusception after extubation,which were cured after conservative treatment.There were 4 cases of recurrence of obstruction,3 cases of children with recurrence of obstruction underwent intestinal intubation again,postoperative recovery was good,and discharged smoothly;1 case of children with recurrence of obstruction improved after conservative treatment,and discharged smoothly.After long-term follow-up,there was no recurrence of obstruction.2.One patient in group B died of meconium peritonitis,intestinal perforation,premature infant and very low birth weight infant.Emergency operation was performed 18 hours after birth,and the family members gave up treatment after operation,and died of disseminated intravascular coagulation(DIC)and septic shock.In group B,3 cases were lost to follow-up,and 1 case(1.9%)had postoperative complications of catheterization,which was caused by infection of stoma.One case of recurrent obstruction was treated with ileostomy and intestinal adhesiolysis after recurrent obstruction.The patient recovered well after operation and was discharged smoothly.No recurrence of obstruction occurred after long-term follow-up.3.The time of first exhaust,oral feeding,hospitalization and intestinal tube placement in group B was shorter than that in group A(P < 0.05);the incidence of postoperative tube related complications(infection at stoma,obstruction at stoma,difficulty in extubation,intussusception during extubation,gastrointestinal fistula)in group B was lower than that in group A(P < 0.05),and the abdominal condition(abdominal distension,abdominal pain,vomiting,constipation,obstruction)in group B after discharge was lower than that in group A(P < 0.05)The incidence of recurrence was lower than that of group A.Conclusion1.Small intestinal intubation is an effective method for the treatment of adhesive small bowel obstruction(ASBO)in children;2.The recovery of children after retrograde intestinal intubation is better than antegrade intestinal intubation;3.The recurrence rate of postoperative intestinal obstruction,the incidence of catheter-related complications,the abdominal condition after discharge were good and the length of hospital stay were reduced;4.It is not only suitable for adults,but also worthy of clinical promotion in pediatric surgery.