新生儿坏死性小肠结肠炎的外科治疗

Surgical Treatment of Infants with Necrotizing Enterocolitis

【目的】探讨新生儿坏死性小肠结肠炎(NEC)外科手术指征、手术方法及影响术后预后的危险因素。【方法】回顾性分析湖南省儿童医院2002年1月至2008年6月58例NEC患儿的临床资料,58例NEC患儿分为非手术组和手术组,术后治愈组和死亡组,进行临床疗效和危险因素(包括孕周、出生体重、腹壁发红、气腹、肠壁积气、固定的肠袢、门静脉积气、血小板计数、动脉血气pH值、呼吸衰竭和手术方式)比较。【结果】58例NEC中行手术治疗27例,治愈17人,死亡10人,治愈率63%。手术组较非手术组并腹壁发红、气腹、固定的肠袢、血小板<100×109/L、动脉血气pH值<7.3的比率高,差异有统计学意义(P<0.05)。术后死亡组较治愈组合并白细胞<5.0×109/L、血小板<100×109/L、动脉血气pH值<7.3和呼吸衰竭的比率高,差异有统计学意义(P<0.05)。【结论】气腹是NEC的绝对手术指征,而腹壁发红、固定的肠袢、血小板<100×109/L、动脉血气pH值<7.3可作为相对手术指征。一期吻合术与肠造瘘术的选择需进一步研究。白细胞<5.0×109/L、血小板<100×109/L、动脉血气pH值<7.3和呼吸衰竭为影响NEC术后预后的危险因素,积极防治NEC合并症可提高NEC的治愈率。

[Objective]To explore the operative indications of infants with necrotizing enterocolitis and to choose operative methods and search the risk factors of prognosis of necrotizing enterocolitis after operation.[Methods] Fifty-eight cases of necrotizing enterocolitis in Hunan Provincial Children＇s Hospital from January 2002 to June 2008 were analyzed retrospectively.Fifty-eight cases of necrotizing enterocolitis were divided into non-operative group,operative group,cured group and death group after operations,and were compared by clinical effect and risk factors（including gestational age,birth weight,abdominal wall erythema,pneumoperitoneum,pneumatosis intestinalis,fixed loop on radiograph,platelet count,arterial blood gas PH,respiratory failure and operative methods）.[Results] Twenty-seven cases of fifty-eight infants with necrotizing enterocolitis underwent laparotomy.Seventeen of them were cured,and ten cases died.The total survival rate was 63%.The incidence rate of abdominal wall erythema,pneumoperitoneum,fixed loop on radiograph,portal venous gas,platelet count 〈100×10^9/L and arterial blood gas PH 〈7.3 in the operative group was more than that in the non-operative group,and there was significant difference between these two groups（P〈0.05）.The incidence rate of leucocyte〈5×10^9/L,platelet count 〈100×10^9/L,arterial blood gas PH 〈7.3 and respiratory failure after operations in the death group was more than that in the cured group,and there was significant difference between these two groups（P〈0.05）.[Conclusion]Pneumoperitoneum is an absolute operative indication for necrotizing enterocolitis.However,abdominal wall erythema,fixed loop on radiograph,platelet count 〈100×10^9/L and arterial blood gas PH 〈7.3 can be regarded as relative indications for surgery.The selection between primary anastomosis and enterostomy need to be further studied.Leucocyte〈5×10^9/L,platelet count 〈100×10^9/L,arterial blood gas PH 〈7.3 and respiratory failure are the risk factors of prognosis of necrotizing enterocolitis after operations.Treating the complications actively can raise the cure rate of necrotizing enterocolitis.