低体重新生儿急腹症的外科治疗

Effects of surgical treatment for low birth weight neonates with critical acute abdomen

目的评价低体重新生儿危重急腹症外科治疗的效果。方法回顾分析2000年1月至2006年1月南京医科大学附属南京儿童医院新生儿外科治疗的228例体重低于2500 g 的新生儿危重急腹症的临床资料,比较胎龄、出生体重及诊治改进与预后的关系。结果患儿入院年龄1 h～7 d,平均(4.1±0.7)d;早产儿141例,足月小样儿87例;出生体重≤2000 g 者26例,2000～2500 g 者202例;2000年1月至2003年1月(前3年组)83例,2003年1月至2006年1月(后3年组)145例。治愈202例,死亡26例(11.4%)。早产儿组,≤2000 g 组,前3年组死亡率[14.89%(21/141)、53.84%(14/26)、18.07%(15/83)]远高于足月小样儿组,2000～2500 g 组和后3年组(x^2=4.455、P<0.05,x^2=52.324、P<0.01,x^2=5.745、P<0.05)。生存患儿随访4～48个月,体重身高达到正常标准。结论早产、出生体重低与新生儿急腹症死亡关系密切;随着新生儿外科手术、产前诊断和围手术期处理水平的提高,低体重新生儿危重急腹症治疗的成功率正在提高。

Objective To evaluate the effects of the surgical treatment in critical acute abdomen in low birth weight neonates. Methods The clinical data of 228 neonates with critical acute abdomen who underwent surgical treatment from January 2000 to January 200, aged （4. 1 ±0.7） days （ 1 h-7 days）, 141 being preterm infants and 87 being small for date infants, 26 with the birth weight ≤ 2000 g and 202 with the birth weight of 2000-2500 g, and 83 cases admitted between Jan 2000 and Dec 2002 （ first 3-year group） and 145 admitted between Jan 2003 and Jan 2006 （last 3-year group）, were analyzed retrospective Followup was conducted for 4 - 48 months. Results Twenty-six pediatric patients died after operation with a hospital mortality rater of 11.4%. The mortality rates of the group of preterm infants, newborns with the birth body weight ≤2000 g, and the first 3-year group were 14.89% （21/141）, 53.84% （ 14/26）, and 18.07% （15/83） respectively, all significantly higher than the full-term small for date infants, newborns with the birth weight of 2000 - 2500 g, and the last 3-year group [ 5.75% （5/87, χ^2 = 4.455, P 〈 0. 05 ）, 5.94% （12/202,χ^2= 52. 324 , P〈 0. 01）; and 7.59% （11/145, χ^2=5.745, P〈 0. 05） respectively. Follow-up showed that all surviving infants had good gastrointestinal functions and approximately normal growth. Conclusion Death of low birth weight neonates with critical acute abdomen is associated with premature birth and low birth weight . With the development of neonatal surgery, prenatal diagnosis, and perioperational therapy, the curative rate of critical acute abdomen in low birth weight neonates is increasing.