新生儿肠道穿孔142例临床特点分析  

Clinical characteristics of 142 cases of neonatal intestinal perforation

作　　者：马宏图[1] 王佚[1] 刘伟[1] 向丽[1] 金先庆[1] 李晓庆[1] 

机构地区：[1]重庆医科大学附属儿童医院胃肠新生儿外科/儿童发育疾病研究教育部重点实验室/儿科学重庆市重点实验室/重庆市儿童发育重大疾病诊治与预防国际科技合作基地,重庆400014

出　　处：《现代医药卫生》2017年第5期675-678,共4页Journal of Modern Medicine & Health

基　　金：国家临床重点专科建设项目(国卫办医函〔2013〕544)

摘　　要：目的分析总结新生儿肠道穿孔的临床特点,指导临床诊疗。方法回顾性分析该院胃肠新生儿外科2006年5月至2016年5月收治的142例新生儿肠道穿孔病历资料的一般情况、临床表现、体格检查、辅助检查、手术发现、治疗及预后等内容,总结新生儿肠道穿孔的临床特点。结果 (1)142例肠道穿孔新生儿主要临床表现为腹胀(128例,90.14%)及呕吐(83例,58.45%),发热仅占30.28%(43/142),另有体温不升3例(2.11%);体征以腹部膨隆(128例,90.14%)、腹膜刺激征(78例,54.93%)、腹壁静脉怒张(67例,47.18%)最常见。(2)142例患儿入院后行腹部立、卧、侧位片,提示消化道穿孔的阳性率为98.59%(140/142)。(3)术中探查穿孔部位为小肠(78例,54.93%)和结肠(64例,45.07%)。小肠穿孔中最常见的部位为回肠(62例,79.49%);结肠穿孔中最常见的部位为横结肠(18例,28.12%)。(4)新生儿肠穿孔常见病因分别为新生儿坏死性小肠结肠炎(94例,66.20%)、先天性肠闭锁(16例,11.27%)、胎粪性腹膜炎(10例,7.04%)、先天性巨结肠(8例,5.63%)。(5)术中根据穿孔部位、肠管生机、腹腔污染程度等选择不同的手术方式,治愈92例(64.79%),放弃治疗49例(34.51%),死亡1例(0.70%)。结论新生儿不明原因腹胀伴呕吐、发热等表现,结合腹部查体应警惕消化道穿孔的可能,通过腹部摄片发现气腹可确诊;确诊后应急诊手术,并根据穿孔部位、肠管生机、腹腔污染程度等选择恰当的治疗方式。Objective Analysis and summarize the clinical characteristics of neonatal intestinal perforation, and guide the clinical diagnosis and treatment. Methods Retrospective analysis of 142 cases of neonatal intestinal perforation in our hospital from May 2006 to May 2016 medical records of the general situation, clinical manifestations, physical examination, auxiliary examination, surgical findings, treatment and prognosis, and summarized the clinical characteristics of neonatal intestinal perforation. Results（1）The main clinical manifestations of 142 cases of intestinal perforation were abdominal distension（128 cases,90.14%） and vomiting（83 cases, 58.45%）, fever accounted for only 30.28%（43 cases）,3 cases of temperaturewas not rise（2.11%）;the most common signs were abdominat bulge（128 cases,90.14%）,peritoneal irritation sign（78 cases,54.93%）,dilated superfical abdominal veins（67 cases,47.18%）.（2）142 cases of children admitted to hospital after the abdomen, lying, lateral position, suggesting that the positive rate of perforation of digestive tract was 98.59%（140/142）.（3）Intraoperative exploration of perforation site in the small intestine（78 cases,54.93%） and colon（64 cases,45.07%）. Small bowel perforation was the most common site of ileum（62 cases,79.49%）; perforation of the colon was the most common was the transverse colon（18 cases,28.12%）.（4）Common causes of neonatal intestinal perforation were neonatal necrotizing enterocolitis（94 cases, 66.20%）, congenital intestinal atresia（16 cases,11.27%）, meconium peritonitis（10 cases, 7.04%）, congenital megacolon（8 cases,5.63%）.（5）The different ways of operation should be chosen according to the site of perforation, bowel vitality, abdominal contamination degree,92 cases（64.79%） were cured, gave up treatment in 49 cases（34.51%）, death in 1 case（0.70%）. Conclusions Neonatal with unexplained abdominal distension accompanied by vomiting,fever,such as performance, combined with abdo

关 键 词：肠穿孔 小肠结肠炎 坏死性 肠胃胀气 婴儿 新生 

分 类 号：R459.3[医药卫生—治疗学]