儿童肠管吻合术。俄罗斯儿科医生的经验

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论证。肠管吻合术是儿科外科标准和严重的外科技术之一。它适用于所有年龄组。医疗技术的发展极大地改变和扩大了外科干预的范围。然而，许多问题仍然具有现实意义，如新生儿肠段明显不协调时进行肠管吻合术的安全性、腹腔镜下肠缝合术的使用、机械缝合机的使用、腹膜炎时的肠管吻合术等。

该研究的目的是确定俄罗斯联邦儿童肠管吻合术领域目前存在的问题和发展前景。

材料和方法。研究基于4558例肠管吻合术的数据，其中包括1735例新生儿手术。数据由包括顿涅茨克人民共和国和卢甘斯克人民共和国在内的75个俄罗斯联邦主体的儿科主任医师提供。该研究纳入了根据调查问卷收集的2021-2022年的数据。我们对数据进行了汇总和统计处理。

结果。本文介绍俄罗斯联邦儿童在不同肠段和不同年龄组进行肠管吻合术的结果。通过腹腔镜方法进行十二指肠吻合术，以及在腹膜炎或肠壁受损的情况下进行十二指肠吻合术，会显著增加失败和重复重建的风险（p < 0.05）。同时，对于大龄儿童来说，使用腹腔镜和缝合机进行小肠吻合术几乎没有并发症，尽管这种手术的频率在急诊和合并症的情况下是其他手术的两倍。一般来说，在不利条件下进行的小肠吻合术与造口关闭时进行的肠管吻合术在统计学上没有明显差异（p > 0.05）。分析表明了，在进行直肠手术、重复重建（如十二指肠吻合）以及肠壁血液供给紊乱时的新生儿小肠吻合术的情况下，吻合失败风险最高。新生儿小肠和大肠手术的死亡率最高，尤其是在存在腹膜炎和循环障碍的情况下。

结论。因此，现阶段俄罗斯联邦肠管吻合术发展的特点是效果良好，扩大肠管受损或腹膜炎情况下的吻合术适应症，以及引进腹腔镜技术和使用机械缝合机。

作者简介

Dmitry A. Morozov

Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery, Pirogov Russian National Research Medical University; Sechenov University

Email: damorozov@list.ru
ORCID iD: 0000-0002-1940-1395
SPIN 代码: 8779-8960

MD, Dr. Sci. (Med.), Professor, Head of the Department of Pediatric Surgery and Urology-Andrology; Director

俄罗斯联邦, Moscow; Moscow

Olga V. Karaseva

Research Institute of Emergency Pediatric Surgery and Traumatology; Problem Committee “Abdominal Surgery” of the Scientific Council of the Russian Association of Pediatric Surgeons

Email: karaseva.o@list.ru
ORCID iD: 0000-0001-9418-4418
SPIN 代码: 7894-8369

Dr. Sci. (Med.), Professor; Deputy Director

俄罗斯联邦, Moscow; Moscow

Sergey М. Sharkov

Sechenov University; Morozov Children’s Municipal Clinical Hospital

Email: sharkov_s_m_1@staff.sechenov.ru
ORCID iD: 0000-0002-9563-6815
SPIN 代码: 4637-6392

MD, Dr. Sci. (Med.), Professor of the L.P. Alexandrov Department of Pediatric Surgery and Urology-Andrology; Head of the City Center for Reproductive Health of Children and Adolescents

俄罗斯联邦, Moscow; Moscow

Kirill D. Morozov

Sechenov University; Morozov Children’s Municipal Clinical Hospital

Email: dr.kirillmorozov@mail.ru
ORCID iD: 0000-0002-6300-1102
SPIN 代码: 7627-5889

Postgraduate Student

俄罗斯联邦, Moscow; Moscow

Maxim I. Ayrapetyan

Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery, Pirogov Russian National Research Medical University; Sechenov University

编辑信件的主要联系方式.
Email: ayrapetyan_m_i@staff.sechenov.ru
ORCID iD: 0000-0002-0348-929X
SPIN 代码: 3683-7312

MD, Cand. Sci. (Med.), Assistant Professor of the L.P. Alexandrov Department of Pediatric Surgery and Urology-Andrology

俄罗斯联邦, Moscow; Moscow

Aleksandr К. Fedorov

Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery, Pirogov Russian National Research Medical University; Sechenov University

Email: fedorov.a@pedklin.ru
ORCID iD: 0000-0001-8927-1971
SPIN 代码: 8548-8115

MD, Cand. Sci. (Med.), Assistant Professor of the L.P. Alexandrov Department of Pediatric Surgery and Urology-Andrology; Head of the Department of Surgery Veltischev Research and Clinical Institute

俄罗斯联邦, Moscow; Moscow

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