新生儿胃穿孔的临床特点及预后分析

Clinical characteristics and prognosis of neonatal gastric perforation

目的 总结新生儿胃穿孔的临床特点,分析其与患儿预后的关系,为提高临床治疗效果提供依据.方法 回顾性分析郑州大学第三附属医院小儿普外科2012年12月至2018年11月收治的62例新生儿胃穿孔患者的临床资料.统计患儿性别、胎龄、出生体质量、穿孔类型、手术时机、发病前应用无创正压气道通气(nCPAP)情况,分析其与患儿预后的关系.结果 62例患儿中47例术后恢复良好且顺利出院,15例死亡,病死率为24.2%.42例(67.7%)患儿术后病理回示存在胃壁肌层缺损.院内发病患儿和他院确诊后转入患儿手术时机比较差异有统计学意义(P<0.05),他院转入患儿自确诊至开始手术的时间长于院内发病患儿.不同性别、胎龄、出生体质量、穿孔类型、发病前有无nCPAP应用病史的新生儿胃穿孔病死率比较差异未见统计学意义(P>0.05);而不同手术时机的患儿病死率比较差异有统计学意义(P<0.05).结论 新生儿胃穿孔发病率男性多于女性,多见于早产儿、低出生体质量儿,穿孔类型以长裂孔状穿孔为主.胃内高压可能是导致新生儿胃穿孔发生的重要原因.该病病情危重、进展快,病死率较高,尽早的手术及合理的术后治疗是患儿康复的关键.

Objective To summarize the clinical characteristics of neonatal gastric perforation and analyze its relationship with the prognosis of neonatal gastric perforation,so as to provide basis for improving clinical therapeutic effect.Methods The clinical data of 62 neonates with gastric perforation admitted to Department of Pediatric General Surgery of the Third Affiliated Hospital of Zhengzhou University from December 2012 to November 2018 were analyzed retrospectively.The gender,gestational age,birth weight,perforation type,operation time and application of non-invasive congtinuous positive airway pressure(nCPAP)before onset were counted for analysis on relationship between clinical characteristics and prognosis of children with gastric perforation.Results Of the 62 cases,47 cases were discharged successfully after the operation,15 cases died with the fatality rate of 24.2%.The pathological findings of 42 cases(67.7%)showed defect of gastric wall muscle layer after operation.There was a significant difference in the timing of surgery between the children with hospital onset and those who were transferred from other hospital after the diagnosis(P<0.05).The time from diagnosis to operation was longer in children who were transferred from other hospital after the diagnosis than hospitalized children.There was no significant difference in the fatality rate of gastric perforation neonates with different genders,gestational ages,birth weight,types of perforation and the history of nCPAP application before onset(P<0.05).However,there was a significant difference in fatality rate among children with different operation time(P<0.05).Conclusions The incidence of gastric perforation in neonates is higher in males than females,which mostly occurred in premature infants(62.9%)and low birth weight infants(69.4%).The perforation type is mainly long hiatal perforation(82.3%).Nearly&nbsp;half of the children have a history of nCPAP before onset.The disease is critical,which progresses rapidly and has a high fatality rate.Early operation and reasonable postoperative treatment are the key to remission.