新生儿坏死性小肠结肠炎手术治疗

Operative treatment of neonatal necrotizing enterocolitis

目的回顾性分析该院近5年新生儿坏死性小肠结肠炎（NEC）手术病例,探讨其手术治疗的适应证、方式及并发症。方法收集2012年1月至2015年12月在该院新生儿重症监护病房住院的96例NEC患儿的一般资料,并按手术时间将其分为小于或等于7 d组和大于7 d组,分别对其分期、手术方式、并发症及预后进行分析。结果近5年该院共收治新生儿NEC手术患儿44例,其中足月儿7例,早产儿37例,足月儿胎龄和出生体质量均大于早产儿,且NEC发病时间早于早产儿,差异均有统计学意义（P〈0.05）。≤7 d组35例患儿包括34例NECⅢ期和1例NECⅡ期患儿,平均手术时间（2.7±1.7）d,术前X线片主要表现为气腹;〉7 d组9例患儿包括3例NECⅢ期和6例NECⅡ期患儿,手术时间18~74 d,中位数为35 d。44例手术患儿中13例死亡,31例存活,手术存活率为70.5%。结论新生儿NEC的手术时机把握尤其关键,可根据术中肠管的坏死程度和范围决定手术方式,术后发生短肠综合征的患儿可以考虑提前回纳以增加肠道长度。

Objective To retrospectively analyze the cases of neonatal necrotizing enterocolitis（NEC） in our hospital during the recent five years and to investigate its surgical indications,operation modes and complications. Methods The general data in 96 cases of NEC in NICU of our hospital from January 2011 to December 2015 were collected and divided into the ≤7 d group and 〉7 d group. The staging,operation modes,complications and prognosis were analyzed in the two groups. Results A total of 44 cases of NEC were treated in our hospital during the recent 5 years,including 7 full-term cases and 37 premature cases. The gestational age and birth weight in full term cases were greater than those in the preterm cases,moreover the NEC onset time was earlier than that in the preterm cases,the difference was statistically significant（P〈0.05）. In 35 cases of the ≤7 d group,34 cases were NEC Ⅲ and1 case was NEC Ⅱ,the average operation timing was（2.7±1.7）d,the preoperative X-ray manifestations were mainly pneumoperitoneum;in 9 cases of the 〉7 d group,3 cases were NEC Ⅲ and 6 cases were NEC Ⅱ,the average operation timing was（18-74）d. Among surgical 44 cases,13 cases died and 31 cases were survival with the survival rate of 70.5%.Conclusion Grasping the operation timing of neonatal NEC is especially important,the operation mode can be determined according to the degree and scope of intraoperative bowel necrosis,for children with possibly postoperative short bowel syndrome,the gut reduction in advance should be considered in order to increase the intestinal tract length.