腹腔引流治疗新生儿坏死性小肠结肠炎的评价  

Peritoneal drainage for treatment of neonatal necrotizing enterocolitis

作　　者：黄姗[1] 易斌[2] 杨星海[1] 赵映珍[1] 

机构地区：[1]湖北省妇女儿童医院小儿外科,武汉430070 [2]华中科技大学同济医学院附属同济医院小儿外科

出　　处：《临床外科杂志》2010年第6期415-416,共2页Journal of Clinical Surgery

摘　　要：目的评价腹腔引流治疗新生儿坏死性小肠结肠炎（NEC）的临床效果。方法2002年1月至2008年12月收治NEC61例，临床分期为改良BellⅡ期。2002年1月至2006年3月34例行保守治疗，2006年4月至2008年12月27例行腹腔引流术。结果保守治疗组和腹腔引流组治愈率分别为55．9％（19例）、81．5％（22例），肠穿孔的发生率分别为32．4％（11例）、7．4％（2例），肠狭窄的发生率分别为35．3％（12例）、11．1％（3例），腹腔内脓肿的发生率为14．7％（5例）、7．4％（2例），分别有38．2％（13例）和7．4％（2例）行手术治疗。腹腔引流组死亡率、肠穿孔、肠狭窄和中转手术的发生率均明显低于保守治疗组。结论早期应用腹腔引流可提高BellⅡ期NEC的治愈率，可避免肠坏死、穿孔，减少并发症的发生。Objective To evaluate the clinical efficacy of peritoneal drainage in neonates with neonatal necrotizing enterocolitis （ NEC ）. Methods Clinical data about 61 NEC neonates who were admitted to our hospital from Jan. 2002 to Dec. 2008 were retrospectively analyzed. The neonates, including 33 males and 28 females, developed clinical symptoms 5 to 12 clays after birth, and were classified to modified Bell Ⅱ stage on admission. Thirty - four patients admitted between Jan. 2002 and Mar. 2006, were treated conservatively. Peritoneal drainage （PD） was performed in 27 patients between Apr. 2006 and Dec. 2008. Results In the conservative treatment group, survival rate, perforation rate, intestinal stric- ture incidence,and intra - abdominal abscess incidence were 55.9% （ 19 cases） ,32.4% （ 11 cases） , 35.3% （6 cases） ,and 14.7% （5 cases） ,respectively. Thirteen patients （38.2%） were converted to the operation. In the PD group, survival rate, perforation incidence, intestinal stricture incidence, and intra - abdominal abscess incidence were 81.5% （22 cases） ,7.4% （：2 cases）,11.1% （3 cases） ,7.4% （2 cases） ,respectively. Only two patients （7.4%） were converted to open surgery. In the PD group,death rate, perforation incidence, intestinal stricture incidence and operation rate were decreased obviously. Conclusion Early application of PD is effective for treatment of NEC at Bell Ⅱ stage. PD can decrease complications and avoid intestinal necrosis and perforation.

关 键 词：新生儿 坏死性小肠结肠炎 腹腔引流 

分 类 号：R574.5[医药卫生—消化系统]