T-type Ileostomy For Neonatal Necrotizing Enterocolitis

Background and PurposeNecrotizing enterocolitis?NEC?is the most common serious acquired gastrointestinal disease in newborns.Necrotizing enterocolitis was first proposed by Schmidt and Quessel in the early 1950s to describe the death of newborns from gastrointestinal necrosis.Until the 1960s,Santulli et al.reported a series of premature infants with NEC in infant hospitals.These premature infants were regarded as a unique group.It was reported that the mortality rate of these infants was between20%and 50%.However,once the infants were diagnosed as neonatal necrotizing enterocolitis,there was no way to change the disease except for symptomatic treatment such as anti-infection and nutrition.Process.In recent years,with the improvement of perinatal medical technology,more and more premature low birth weight infants,even premature very low birth weight infants survive,and the incidence of NEC also shows a gradual increase trend.The main clinical manifestations of NEC are abdominal distension,vomiting and stool.Severe cases may be complicated by systemic inflammatory reaction,shock and multiple organ failure,with a high mortality.The treatment of NEC includes medical treatment and surgical treatment.At present,there are three main surgical methods for NEC:abdominal drainage,enterotomy and enterostomy.Some people believe that enterostomy has the best therapeutic effect.The complications of short bowel syndrome,dehydration and electrolyte disturbance occur frequently due to the long opening time of the stoma after NEC enterostomy and the difficulty of nutrient absorption.In order to reduce the complications and reduce the pain of children and the burden of their families,T-type ileostomy was introduced in pediatric general surgery of our hospital.To explore the advantages and disadvantages of double-lumen ileostomy and double-lumen ileostomy,double-lumen ileostomy and T-type anastomosis ileostomy were used respectively for eligible children.Materials and Methods1 Research materials and groupingSixty cases of ileostomy due to neonatal necrotizing enterocolitis in pediatric general surgery department of our hospital from July 2017 to August 2018 were collected.35 cases were treated with double-lumen ileostomy?control group?and 25cases were treated with T-type ileostomy?experimental group?.The follow-up period ranged from 4 months to 1 year.To analyze the advantages and disadvantages of T-type ileostomy and double-lumen ileostomy in the surgical treatment of neonatal necrotizing enterocolitis.2 Observe indicators2.1 Preoperative conditions of the experimental group and the control group:general data of the two groups,such as gestational age,age of operation,weight,sex and mode of delivery;laboratory test data of the experimental group and the control group,such as white blood cells,C-reactive protein,calcitonin,platelets,hemoglobin,albumin,etc.2.2 Intraoperative conditions of the experimental group and the control group:operation time,intraoperative bleeding volume,proximal small intestine length?from the stoma to the beginning of jejunum?.2.3 Postoperative conditions of children in experimental group and control group:complications after operation:incision dehiscence,intestinal tube prolapse,intestinal tube retraction,etc.Survival status of children after operation:unplanned re-hospitalization cases?due to dehydration,electrolyte disturbance?,average monthly weight gain,etc.Laboratory test data:such as white blood cells,C-reactive protein,calcitonin,platelets,hemoglobin,white blood cells,etc.Protein and so on;the time of fistula defecation and feeding after operation.3.Statistical analysisSPSS17.0 software was used to analyze the counting data.The counting data were expressed by frequency and rate.The?2 test was used.There was theoretical frequency 1<T<5.The theoretical frequency T<1 was calculated by?2continuity correction formula.Fisher exact probability method was used to calculate the theoretical frequency T<1.The measurement data was expressed by`x±s and t-test was used.The difference was statistically significant with P<0.05.Result1 The preoperative conditions of the two groups were as follows1.1 General data:There was no statistical difference between the experimental group and the control group in gestational age,operative age,weight,sex and delivery mode.1.2 Laboratory data:There was no statistical difference between the experimental group and the control group in white blood cells,C-reactive protein,calcitonin,platelets,hemoglobin and albumin.2 Intraoperative conditions of two groups of childrenTwo groups of children intraoperative comparison:experimental group and control group intraoperative bleeding volume,proximal small intestine length no statistical difference;experimental group operation time is greater than the control group,the difference is statistically significant.3 Postoperative status of two groups of children3.1 Comparisons of general conditions after operation between the two groups:There were statistical differences in average hospitalization time and survival status between the two groups.The average hospitalization time of the experimental group was shorter than that of the control group,and the mortality rate of the control group was higher than that of the experimental group.There was no statistical difference in incision dehiscence,adhesive intestinal obstruction and intestinal retraction between the two groups;intestinal tube prolapse,short bowel syndrome and unplanned re-hospitalization(due to dehydration The incidence of anastomotic leakage in the experimental group was higher than that in the control group,and the difference was statistically significant.3.2 Comparisons of laboratory data and nutritional status after operation between the two groups:the changes of leucocyte,C-reactive protein,platelet and calcitonin after operation in the two groups were basically the same;the average monthly weight gain in the experimental group was better than that in the control group;there was no statistical difference between the two groups in the time of fistula defecation and the time of starting feeding after operation;and the hemoglobin in the control group?from post-operation to pre-discharge?Abnormal?<90g/L?,abnormal Na⁺concentration?<135mmol/L,>145mmol/L?,abnormal K⁺concentration?<3.5mmol/L,>5.5mmol/L?and abnormal Ca²⁺concentration?<2.25mmol/L?were more common in the experimental group than in the control group.Albumin was abnormal in both groups?<30g/L?.ConclusionsT-type anastomosis can reduce the incidence of short bowel syndrome and fistula intestinal tube prolapse in neonatal necrotizing enterocolitis,which has some advantages over ileostomy,but increases the risk of anastomotic fistula.Clinical application is recommended for children with short proximal small intestine.