低出生体质量新生儿坏死性小肠结肠炎手术治疗结果分析

Surgical management of low birth weight infants with necrotizing enterocolitis

目的探讨低出生体质量新生儿坏死性小肠结肠炎（NEC）的手术治疗及预后。方法回顾性分析2003年1月至2013年12月间我院收治的670例低出生体质量NEC病例临床资料，根据患儿出生体质量分为极低出生体质量（ELBW）组（〈1500g，241例）及低出生体质量（LBw）组（1500-2500g，429例），分析比较两组患儿的手术率，对两组中手术患儿的手术指征，手术方式，术后并发症发生率及术后30d生存率进行比较分析。结果670例中197例NEC患儿接受了外科手术治疗，其中63例为BellⅡ期，134例为BellⅢ期。总体手术率为29．4％，患儿平均出生孕周为（31±2）周，平均出生体质量为（1561±502）g，平均手术年龄为（14．5±17）d。ELBW与LBW组手术例数分别为117例与80例，ELBW组手术率明显高于LBW组（48．5％1：L18．6％，P〈0．01）。两组首要的手术指征均为气腹（74．4％比70．0％，P〉0．05）。93．9％（185例）患儿接受剖腹探查术，其中10例行一期肠切除肠吻合术，175例行肠造瘘术。另有12例仅行腹腔引流手术。术后并发症发生率为46．2％。最常见并发症为败血症与肠狭窄。两组患儿术后短期生存率则无明显差异（73．5％比82．5％，P〉0．05）。结论外科手术在低出生体质量新生儿重度NEC的治疗中发挥重要作用。气腹是绝对的手术指征，最主要的手术方式为肠造瘘术，正确手术方法的选择能够有效提高NEC患儿尤其是极低出生体质量患儿术后短期生存率。

Objective To evaluate the surgical procedures applied, and the survival of low birth weight （LBW） infants with Necrotizing enterocolitis （NEC）. Methods 670 LBW infants with NEC were analyzed retrospectively from Jan. 2003 and Dec. 2013. All of the patients were divided into 2 groups according to their birth weights., extremely low birth weight （ELBW） group （〈1 500 g, n = 241） and LBW group （1 500 g-2 500 g, n = 429）. Data collected include operative rates, indications for operation, operations performed, complications, and 30-day survival rates. Results 197 of 670 infants with NEC underwent surgical intervention. There were 63 patients in Bell stage Ⅱ and 134 patients in Bell stage Ⅲ. The total operative rate was 29. 4%. The mean gestational age was 31 ± 2 weeks. The mean birth weight was 1 561 ± 502 grams. The mean age at operation was 14. 5 ± 17 days. 48. 5% （117/241） had surgery for NEC in ELBW group while 18. 6% （80/429） in LBW group （P〈0. 01 ）. Pneumoperitoneum was the most common indication for operation in both ELBW and LBW groups （74. 4% vs 70. 0%, P〉0. 05）. 93. 9% of patients were treated with primary laparotomy （10 primary anastomosis and 175 enterostomy）, whereas peritoneal drainage was performed in 12 patients. The postoperative complication rate was 46. 2%. The common postoperative complications were sepsis and intestinal strictures. Furthermore, there was no difference in postoperative survival rates between the groups （73.5% vs. 82. 5%, P〉0. 05）. Conclusions The surgical management plays important role in NEC treatments. Pneumoperitoneum is the most common indication for operation. The most ommon surgical procedure applied is enterostomy. It is effective to improve the postoperative survival rate especially in ELBW infants.