先天性肠旋转不良伴胃穿孔或肠坏死的相关因素分析  

Relative factors analysis for gastric perforation or intestinal necrosis in congenital intestinal malrotation

作　　者：桂琳玲 余雷[1] 鲁巍 邢福中[1] 肖必栋 Gui Linling;Yu Lei;Lu Wei;Xing Fuzhong;Xiao Bidong(Department of Neonatal Surgery,Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430016,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院新生儿外科,武汉430016

出　　处：《临床小儿外科杂志》2022年第1期69-73,共5页Journal of Clinical Pediatric Surgery

基　　金：武汉市卫生和计划生育委员会科研项目(WX17C15)。

摘　　要：目的探讨先天性肠旋转不良伴胃穿孔或肠坏死的相关因素。方法回顾性分析2012年1月至2019年12月武汉儿童医院收治的216例接受手术治疗的先天性肠旋转不良患儿临床资料。采用多因素Logistic回归分析先天性肠旋转不良伴胃穿孔或肠坏死的相关因素。观察指标包括性别,年龄,出生体重,胎龄,发病时间,有无胆汁性呕吐、便血及腹胀,血清总蛋白、白蛋白、血红蛋白以及C反应蛋白水平。结果216例先天性肠旋转不良患儿中,经手术证实伴胃穿孔或肠坏死25例,其中男19例,女6例。单因素分析结果显示发病时间短,无胆汁性呕吐,便血,腹胀,CRP水平高以及总蛋白、白蛋白、血红蛋白水平低是先天性肠旋转不良伴胃穿孔或肠坏死的相关因素(P<0.05)。多因素Logistic回归分析结果显示,腹胀(OR=0.96)、CRP水平高(OR=0.01)、血红蛋白水平低(OR=1.05)是肠旋转不良伴胃穿孔或肠坏死的相关因素(P<0.05)。以CRP浓度16.4 mg/L为临界值评价肠旋转不良伴胃穿孔或肠坏死的发生风险,其敏感性为76.0%,特异性为94.6%,ROC曲线下面积为0.89(P<0.05)。结论先天性肠旋转不良并中肠扭转可导致胃穿孔、肠坏死等严重并发症。中肠扭转程度越严重,越容易导致肠缺血坏死。肠旋转不良患儿出现腹胀、血红蛋白降低及CRP升高时,常提示肠扭转坏死或胃肠穿孔,需尽早手术探查。Objective To explore the relativefactors of congenital intestinal malrotation(CIM)with gastric perforation and intestinal necrosis and explore the operative intervention factors in neonates.Methods Between January 2012 and December 2019,a retrospective study was performed for 216 CIM neonates.Risk factors were identified by univariate and multivariate analyses.Clinical and laboratory parameters included gender,age,birth weight,gestational age,onset time,bilious emesis,bloody stool,abdominal distension,total protein,albumin,hemoglobin and C-reactive protein(CRP).Results There were 19 boys and 6 girls with a surgically confirmed diagnosis of CIM with gastric perforation or intestinal necrosis.In univariate analysis,warning signs for gastric perforation or intestinal necrosis were non-bilious emesis,short onset time,bloody stool,abdominal distension,low level of total protein,albumin,hemoglobin and elevated CRP(P<0.05).Multivariate Logistic regression analysis revealed that independent predictive factors were anemia,abdominal distension and elevated CRP(OR values 0.96,0.01,1.05 respectively,P<0.05).Serum CRP level>16.4 mg/L had a sensitivity of 76.0%and a specificity of 94.6%for gastrointestinal perforation and necrosis in CIM,Area under the receiver operating characteristic(ROC)curve was 0.89(P=0.00).Conclusion CIM with volvulus may lead to such serious complications as gastric perforation and intestinal necrosis.The more advanced degree of midgut volvulus,the higher probability of causing volvulus necrosis.Specific clinical manifestations and laboratory parameters are helpful in the identification of gastric perforation and intestinal necrosis in CIM neonates and surgical exploration should be performed as soon as possible.

关 键 词：先天性肠旋转不良/并发症 肠扭转 胃穿孔 肠坏死 婴儿 新儿 

分 类 号：R725.7[医药卫生—儿科]