新生儿坏死性小肠结肠炎致结肠穿孔手术方式探讨  

The surgical methods of colonic perforation caused by necrotizing enterocolitis in neonates

作　　者：张馨尹[1] 曹建[1] 刘清爽[1] 刘伟[1] ZHANG Xinyin;CAO Jian;LIU Qingshuang;LIU Wei(Department of Neonatology Children′s Hospital of Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/National Clinical Research Center for Child Health and Disorders/Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院新生儿科/儿童发育疾病研究教育部重点实验室/国家儿童健康与疾病临床医学研究中心/儿科学重点实验室,重庆400014

出　　处：《现代医药卫生》2021年第11期1818-1820,1824,共4页Journal of Modern Medicine & Health

摘　　要：目的通过对新生儿坏死性小肠结肠炎致结肠坏死穿孔的患儿进行回顾性分析,探讨最佳手术方式。方法选取2018年5月1日至2020年5月1日该院新生儿坏死性小肠结肠炎致结肠坏死穿孔的患儿47例作为研究对象,将其分为坏死结肠切除组(对照组,n=21)及坏死结肠修补组(观察组,n=26),利用SPSS20.0统计软件对疗效及临床转归进行分析。结果观察组急诊手术时间明显短于对照组,而在炎症恢复时间及关瘘手术持续时间方面均长于对照组,差异均有统计学意义(P=0.04、0.04、<0.01);两组患儿在术后呼吸机使用时间、进食时间、术后肠外营养支持时间、住院时间及术后并发症等临床转归方面比较,差异均无统计学意义(P>0.05)。结论2种手术方式均可作为新生儿坏死性小肠结肠炎致结肠坏死穿孔的处理方式,而最佳手术方式的选择取决于新生儿手术时的状态。在新生儿基础条件差、血流动力学不稳定等情况下可选择结肠修补术,而在患儿生命体征稳定情况下可选择结肠坏死切除术。Objective Through retrospective analysis of the neonates with colon perforation caused by necrotizing enterocolitis,to explore the best choice of surgical methods.Methods Neonates with colon perforation caused by necrotizing enterocolitis from May 1,2018 to May 1,2020 were selected as the research objects,and they were divided into resection group(control group,n=21)and repair group(observation group,n=26).The curative effect and clinical outcome were analyzed by SPSS20.0 software.Results The emergency operation time of the observation group was significantly shorter than that of the control group,while the inflammatory recovery time and the ostomy closure time of the observation group were longer than those of the control group;There were no statistically significant differences in mechanical ventilation time,feeding time,parenteral nutrition time,hospital stay time and postoperative complications between the two groups(P=0.04,0.04,<0.01).Conclusion Both methods can be used as the treatment of colonic perforation caused by necrotizing enterocolitis in neonates.The choice of surgical methods depends on the state of the newborn at the time of surgery.Enteroplasty is an option for neonates with poor basic conditions and unstable hemodynamics,while enterotomy is an option for neonates with stable vital signs.

关 键 词：新生儿 坏死性小肠结肠炎 结肠穿孔 手术方式 临床转归 

分 类 号：R722.19[医药卫生—儿科] R726.1[医药卫生—临床医学]