腹部X线量表在新生儿坏死性小肠结肠炎中的应用价值

Value of radiographic assessment scale in necrotizing enterocolitis

目的评价腹部X线量表在新生儿坏死性小肠结肠炎中的诊断价值及在手术选择中的意义。方法将2005年1月至2011年3月收住入院的61例新生儿坏死性小肠结肠炎患者根据Bell分期标准分为NECⅠ组(25例),NECⅡ组(11例),NECⅢ组(25例)。统计患儿的出生胎龄、性别、体重、临床表现、治疗方法及预后,并对患儿的腹部X线进行量表评分。结果 NECⅠ组、Ⅱ组、Ⅲ组的X线量表评分分别为3.2±1.4、5.3±1.7、8.9±1.7(χ2=39.006,P<0.05),NECⅢ组的分数最高,NECⅠ组的分数最低。NECⅢ组手术患儿和非手术患儿的X线评分分别为8.7±1.8和9.4±1.2,差异无统计学意义。肠穿孔组的X线评分(9.6±1.1)高于肠坏死组(6.8±1.8)(P<0.05)。手术组患儿X线量表分数为7分以上者占80%。NECⅠ组治疗好转率为96%,NECⅡ组好转率为64%。NECⅢ组患儿中,手术组痊愈出院患儿占71%,非手术组只有9%的患儿好转。结论腹部X线量表可以评估新生儿坏死性小肠结肠炎的病情严重程度,X线评分在7分及以上是手术干预的指征。NECⅢ期患儿行外科手术治疗短期疗效好。

Objective This study was conducted to determine the value of the radiographic assessment scale in the diagnosis of neonatal necrotizing enterocolitis,and as measured by need for surgery.Methods A total of 61 neonates were classified into three groups according to the Bell′s Staging Criteria： NECⅠ（n=25）,NECⅡ（n=11） and NEC Ⅲ（n=25）.Data on gestational age at birth,gender,birth weight,clinical manifestations,treatment and prognosis of the patients were collected.Radiographic assessment scale scores were evaluated by a pediatric radiologist.Results Radiographic assessment scale scores in the NECⅠ,NECⅡand NEC Ⅲ groups were 3.2±1.4,5.3±1.7 and 8.9±1.7,respectively（P0.05）.The score was highest in the NEC Ⅲ group and lowest in the NECⅠgroup.Based on the different therapies,the NEC Ⅲ group was subdivided into operative and non-operative groups.Radiographic assessment scale scores in the two subgroups were 8.71±1.86 and 9.36±1.21 respectively（P0.05）.Radiographic assessment scale scores in neonates with intestinal perforation（9.6±1.1） were higher than in those with intestinal necrosis（6.8±1.8）（P0.05）.The majority of patients（80%） who underwent operation had radiographic assessment scale scores above 7.The effective rate was 96% and 64% respectively in the NECⅠand the NECⅡ groups.Of the children in the NECⅢ group,the cure rate was 71% in the operative group,and the effective rate was 9% in the non-operative group.Conclusions The radiographic assessment scale may be used to evaluate the severity of disease in neonates with NEC.Patients with a score on the radiographic assessment scale above 7 have indications for surgical intervention and have better short-term treatment response rates.