不同病变范围新生儿坏死性小肠结肠炎手术干预效果分析  

Outcomes of surgical intervention for necrotizing enterocolitis within different pathological range

作　　者：陈发玲 徐伟珏[1] 李龙至 黄雄[1] 孙俊[1] 吴一波[1] 盛庆丰[1] 吕志宝[1] 

机构地区：[1]上海市儿童医院,上海交通大学附属儿童医院普外科,200062

出　　处：《中华实用儿科临床杂志》2016年第23期1783-1786,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨不同病变范围新生儿坏死性小肠结肠炎（NEC）外科手术干预的效果。方法回顾性分析2011年12月至2015年12月上海市儿童医院手术治疗的25例NEC患儿的临床资料，根据不同肠管坏死范围分为单个坏死或穿孔的病灶（F），多发坏死或穿孔病灶（M），全肠道病变（P） 3组，并对3组患儿的手术方式、术后生存率和关闭造瘘进行比较分析。结果25例患儿中，有11例为F、8例为M、6例为P，均采用剖腹探查术、肠造瘘术，或仅做腹腔引流术；12例为极低出生体质量儿，7例为低出生体质量儿，6例为正常出生体质量儿。有消化道穿孔17例（9例气腹，8例无气腹），无消化道穿孔8例（4例无气腹，4例NEC保守治疗后肠狭窄）。3例患儿经过2次以上手术，其余患儿在造瘘术后3～6个月行造瘘关闭手术。术后生存率：F组为100.0%（11/11例），M组为62.5%（5/8例），P组为16.7%（1/6例）。3种病变范围中F组比M组、P组的生存率高，差异均有统计学意义（χ^2＝4.898、10.312，P均〈0.05）；M组与P组生存率比较差异无统计学意义（χ^2＝1.367，P〉0.05）。结论NEC病变范围与患儿预后明显相关，F比M、P的预后好，极低出生体质量儿占NEC患儿比例较大；术中尽可能地保护边缘肠管是提高患儿存活率和生存质量的关键。造瘘关闭手术建议在造瘘术后3～6个月，待患儿肝功能、肠功能恢复、营养发育良好时进行，特殊情况建议提前或延迟关造瘘。ObjectiveTo explore the surgical intervention outcomes of necrotizing enterocolitis （NEC） patients with different extent of the disease.MethodsThe data of 25 pediatric patients with NEC who were treated with surgical intervention in Shanghai Children′s Hospital from December 2011 to December 2015 were retrospectively analyzed.According to the extent of the disease, the patients were divided into 3 groups： focal disease（F）, multisegmental disease（M）, and pan-involvement（P）. The information including operation style, survival rate and time for close ostomy was analyzed.ResultsThere were 11 cases with F, 8 cases with M, and 6 cases with P. All patients received laparotomy surgery, colostomy, or peritoneal drainage.There were 12 patients with very low birth weight, 7 patients with low birth weight, 6 patients with normal birth weight in this study.There were 17 cases with gastrointestinal perforation （9 cases with pneumoperitoneum, 8 cases without pneumoperitoneum）, 8 cases without digestive tract perforation （4 cases without pneumoperitoneum, 4 cases with enterostenosis after conservative treatment）. In this study, close ostomy was commonly conducted 3-6 months after the operation, except for 3 cases who received 2 or more times of operation.The survival rate in F group was 100.0%（11/11 cases）, higher than those in the M group with 62.5%（5/8 cases） and P group with 16.7%（1/6 cases）（χ^2=4.898, 10.312, all P〈0.05）. However, there was no difference between M group and P group （χ^2=1.367, P〉0.05）.ConclusionsThe extent of disease is correlated to the outcomes of surgical intervention, as F had a better outcome than M and P. Low birth weight is a risk factor for NEC.Protecting the edge of the bowel is a key factor to ensure the survival and improve the quality of life of NEC patients.Close ostomy should be considered when the patients are in a stable condition （liver function and intestinal function recovery, good nutrition condition, etc）, and under special circum

关 键 词：坏死性小肠结肠炎 病变范围 开腹手术 肠造瘘 预后 

分 类 号：R722.1[医药卫生—儿科]