早产儿和/或低出生体重儿消化道手术后非计划二次手术原因分析  

A retrospective study of unplanned reoperation after gastrointestinal surgery in premature and/or low-birth-weight neonates

作　　者：吴晓霞 任红霞[2] 詹江华[3] 靳园园[2] Wu Xiaoxia;Ren Hongxia;Zhan Jianghua;Jin Yuanyuan(Graduate College,Tianjin Medical University,Tianjin 300070,China;Department of Pediatric Surgery,Children's Hospital of Shanxi Province,Taiyuan 030013,China;Department of Pediatric Surgery,Tianjin Children's Hospital,Tianjin 300134,China)

机构地区：[1]天津医科大学研究生院,300070 [2]山西省儿童医院外科,太原030013 [3]天津市儿童医院外科,300134

出　　处：《中华小儿外科杂志》2021年第1期12-16,共5页Chinese Journal of Pediatric Surgery

基　　金：山西省重点研发计划项目(201803D31181)。

摘　　要：目的探讨早产儿和/或低出生体重儿消化道手术后非计划二次手术的原因及预防措施,吸取教训,降低非计划二次手术发生率,提高医疗质量。方法回顾性分析山西省儿童医院2008年1月至2018年5月行消化道手术治疗的214例早产儿和/或低出生体重儿的临床资料和随访资料。患儿胎龄范围为26+3~39+2周;出生体重范围为0.93~4.80 kg。其中,12例早产儿和/或低出生体重儿行非计划二次手术(男6例,女6例),出生体重为(2.19±0.26)kg,手术时体重为(2.14±0.31)kg,胎龄为(35.43±1.94)周,手术时年龄为(3.87±3.66)d。非计划二次手术发生率为5.61%(12/214),发生原因包括吻合口漏3例、粘连性肠梗阻3例、肠闭锁术后合并坏死性小肠结肠炎2例、肠穿孔2例、肠坏死1例、造瘘口切口裂开1例。结果12例行非计划二次手术的患儿中7例痊愈出院,4例死亡,1例放弃治疗后失随访。1例胎粪性肠梗阻患儿因合并胆道闭锁于2个月龄行葛西手术;余6例随访3~12个月生长发育基本正常。结论合理的术式选择、术中精细操作可以降低早产儿和/或低出生体重儿非计划二次手术发生率。加强早产儿和/或低出生体重儿围手术期监管,早期发现术后并发症并采取相应的措施可改善预后、提高生存率。Objective To explore the causes and preventive measures of unplanned reoperation after gastrointestinal surgery in premature and/or low-birth-weight(LBW)neonates.Methods Clinical and follow-up data were retrospectively analyzed for 214 premature and/or LBW neonates undergoing abdominal surgery from January 2008 to May 2018 at Children's Hospital of Shanxi Province.Gestational age was 26+3 to 39+2 weeks and birth weight 0.93 to 4.80 kilogram.Half of them(6 boys and 6 girls)underwent unplanned reoperation.The mean birth weight was 2.19 kilograms,operative weight(2.14±0.31)kilograms,gestational age(35.43±1.94)weeks and mean operative age(3.87±3.66)days.The rate of unplanned reoperation was 5.61%.The causes of unplanned reoperation were anastomotic leakage(n=3),adhesive intestinal obstruction(n=3),postoperative necrotizing enterocolitis(n=2),intestinal perforation(n=2),intestinal necrosis(n=1)and incision dehiscence(n=1).Results Seven cases recovered,4 died and 1 lost to follow-ups.One 2-month-old case underwent Kasai procedure for biliary atresia.The growth and development of another 6 children were basically normal during a follow-up period of 3-12 months.Conclusions Appropriate operative approach and meticulous intraoperative handling may reduce the incidence of unplanned reoperation in premature or LBW neonates.Strengthening the perioperative supervision,early detection of postoperative complications and taking appropriate measures improve the prognosis.

关 键 词：早产 低出生体重 非计划二次手术 医疗质量 

分 类 号：R726.5[医药卫生—儿科]