新生儿肠壁肌层缺损并穿孔8例临床分析  

Clinical analysis of 8 cases of neonatal intestinal muscle defect with perforation

作　　者：陆巍峰[1] 耿其明[2] 

机构地区：[1]南京医科大学附属南京儿童医院外科ICU,210008 [2]南京医科大学附属南京儿童医院新生儿外科,210008

出　　处：《中华实用儿科临床杂志》2016年第19期1493-1495,共3页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨新生儿肠壁肌层缺损并穿孔的临床特点、治疗和预后。方法回顾性分析南京医科大学附属南京儿童医院2006年1月至2015年12月收治的8例肠壁肌层缺损并发穿孔的新生儿病例的临床资料。结果8例中早产和足月小样儿各1例，6例为足月正常出生体质量儿，发病年龄均〈7 d，无围生期窒息史。临床均表现为哭闹和突发的明显腹胀，5例有胆汁或粪汁样呕吐。合并先天性肛门直肠畸形5例，其中低位畸形3例，中、高位畸形各1例，未合并其他消化道畸形。8例均采用手术治疗，术中证实直肠穿孔7例，回肠穿孔1例，均为单一穿孔，穿孔直径0.8～2.0 cm，穿孔边缘肠壁呈膜状，予彻底切除病变组织后行肠修补，直肠穿孔者同时行近端结肠造口。病理检查显示切除的穿孔周缘组织黏膜完好、固有肌层缺如、肌肉缺失区无残留肌间丛。2例于肠造瘘术后1 d内自动出院，6例根治术后除合并高位肛门直肠畸形者控制排便功能不佳外，无其他消化道不适症状。结论新生儿肠壁肌层缺损并穿孔以直肠最为多见，且为单一的大口径穿孔，多为足月正常出生体质量儿，常合并先天性肛门直肠畸形，高、中、低位畸形均可伴发。手术需彻底切除病变组织，原则上应行穿孔近端肠造口。先天性肛门直肠畸形并消化道穿孔者，直肠应作为手术时探查的重要区域。出生后早期突发起病的临床特征和病理所见倾向于新生儿肠壁肌层缺损是一种原发病变。除合并畸形导致的并发症外，预后满意。Objective To study the clinical characteristics,treatment and prognosis of neonatal intestinal muscle defect with perforation. Methods The clinical data of 8 cases of newborns who had intestinal muscle defect with perforation in Department of Surgical Intensive Care Unit, Nanjing Children＇s Hospital Affiliated to Nanjing Medical University,were analyzed retrospectively. Results These 8 cases included 1 premature infant, 1 term low birth weight infant ,6 cases of term infants with normal birth weight, and all had no history of perinatal asphyxia. The ages of onset of all cases were 〈 7 d. Clinical manifestations were crying and sudden onset of obvious abdominal distention. Bile or fecal vomiting occurred in 5 cases. These patients included 5 cases with congenital anorectal malformations, of which 3 cases had low deformity, 1 case with middle deformity and 1 case with high deformity,with no other complications of gastroin- testinal malformation. Surgical treatment was used in 8 cases,in which 7 cases of rectal perforation and 1 case of ileal perforation were confirmed. All cases were isolated perforation with a diameter of about 0.8 -2. 0 cm. The perforated pe- riphery of the intestine was membranous. Intestinal repair was performed after total removal of the diseased tissue, and the patients with rectal perforation were performed at the same time for the proximal colostomy. The histopathologic examinations showed that the periphery of perforation had intact mucosa,muscularis propria was absent, myenteric plexus was absent in the region of muscle loss. Two cases were discharged within 1 d after colostomy. Except for 1 case with high anorectal malformation in the control of poor defecation functions, there were no other postoperative gastrointestinal complications in these 6 cases. Conclusions Rectal perforation is the most common in neonatal intestinal muscle de- fects, and it is an isolated and large diameter perforation. Most cases are term infants with normal birth weight. These patients are often associated

关 键 词：肠穿孔 肠壁肌层缺损 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]