新生儿坏死性小肠结肠炎的手术指征探讨  

Indications of surgical treatment for necrotizing enterocolitis

作　　者：唐维兵[1] 刘翔[2] 耿其明[1] 程锐[1] 韩树萍[3] 蒋梨[4] 胡毓华[5] 徐小群[1] 

机构地区：[1]南京医科大学附属南京儿童医院,210008 [2]安徽省立儿童医院 [3]南京市妇幼保健院 [4]东南大学附属中大医院 [5]江苏省妇幼保健院

出　　处：《中华小儿外科杂志》2015年第2期100-104,共5页Chinese Journal of Pediatric Surgery

基　　金：国家自然科学基金（81370473）

摘　　要：目的探讨新生儿坏死性小肠结肠炎的手术干预时机和预后，为新生儿坏死性小肠结肠炎的规范化治疗提供依据。方法前瞻性研究新生儿坏死性小肠结肠炎的手术指征。从2009年7月至2014年6月，在江苏和安徽地区5家新生儿医疗中心以出现腹腔游离气体、弥漫性腹膜炎、腹腔包块、肠鸣音消失等症状之一作为新生儿坏死性小肠结肠炎手术指征（后5年组），与这5家新生儿医疗中心从2004年6月至2009年6月以腹腔出现游离气体为手术指征作为对照（前5年组），对不同手术指征下患儿手术干预率、病死率进行比较。结果前5年组手术干预率14％，显著低于后5年组（25％），两组BellⅡ期和Ⅲ期患儿的手术率均显著提高（P％0．05）；前后5年手术组的病死率差异无统计学意义（14％比13％）；手术指征改变后，患儿的总体病死率由前5年的21％显著下降到后5年组的12％（P〈0．05）。结论新生儿坏死性小肠结肠炎的手术指征，除了腹腔出现游离气体外，还要根据患儿的腹部体征，综合分析病情变化，及时给予手术干预，提高生存率。手术本身对患儿病死率没有显著影响。Bell分期反应患儿总体病情程度，但不能完全依赖Bell分期作为手术指征。Objective To explore the timing of surgical intervention and prognosis of neonatal necrotizing enterocolitis （NEC） so as to provide rationales for its standardized treatment. Methods A prospective study was conducted for surgical indications of NEC. The surgical indication of NEC was one of such symptoms as free intraperitoneal gas, diffuse peritonitis, abdominal mass, disappearance of bowel sounds at five neonatal medical centers of Jiangsu and Anhui areas from July 2009 to June 2014 （later 5-year group）. For the control, the surgical indication was the presence of free intraperitoneal gas from June 2004 to June 2009 （first 5-year group）. And the surgical intervention rate and mortality were compared for different surgical indications. Results The surgical intervention rate of first 5-year group was significantly lower than that of later 5-year group （14% vs 25%, P〈0. 05）. The surgical intervention rates of Bell stages Ⅱ and Ⅲ significantly increased after altered surgical indications （P〈0. 05）. The mortalities had no significant difference between two surgical groups. But the overall mortality significantly decreased from 21% of first 5-year group to 12% of later 5-year group （P〈0. 05）. Conclusions The surgical indications for NEC should consider both abdominal signs and free intraperitoneal gas. Timely surgical intervention should he offered to improve the patient survival. Surgery itself has no significant impact on mortality. Bell staging system may gauge the severity of disease. However it should not be regarded as an absolute surgical indication.

关 键 词：小肠结肠炎 坏死性 外科手术 新生儿 

分 类 号：R726.5[医药卫生—儿科]