新生儿暂时性短肠综合征治疗体会

Management experiences of newborns with temporary short bowel syndrome prior to enterostomy closure

目的探索肠外营养（parenteral nutrition, PN）对新生儿暂时性短肠综合征（temporary short bowel syndrome, TSBS）患儿造瘘期间的治疗作用，并对防治并发症进行探索。方法回顾性分析2001年1月至2015年12月在我院PN支持治疗的21例新生儿TSBS患儿的诊疗经过，并对其进行随访。结果符合入组标准的患儿共21例，所有患儿均在新生儿期因各种原因行高位小肠造瘘术，术后需长期依赖PN。其中男12例，女9例。入院年龄1d至8个月（中位年龄2个月），随访3-140个月，中位随访时间21个月。随访至2015年12月时，存活15例，病死6例；存活组中13例关瘘，2例未关瘘；病死组中2例关瘘，4例未关瘘。经Fisher＇s Exact检验，病死组患儿均发生并发症，存活组仅5例发生并发症（P＝0.012）；病死组中3例保留回盲部，存活组中9例保留回盲部，两组间差异无统计学意义。经Student t检验，病死组存留小肠长度（57.5±14.1）cm，显著短于存活组（115.9±46.7）cm （P＝0.008）。两组患儿的出生体重及入院时年龄别体重z值无统计学意义。结论新生儿TSBS患儿存留小肠越短，并发症发生率越高，死亡风险越大。合理营养支持对该类患儿后续治疗意义重大，积极随访对预防、早期发现和治疗相关并发症作用明显。

Objective To explore the therapeutic effect of parenteral nutrition on newborns with temporary short bowel syndrome （TSBS） and examine the possibilities of preventing and curing complications. Methods Clinical diagnosis and treatment were retrospectively analyzed for 21 hospitalized children with TSBS between January 2001 and December 2015. Results A total of 21 newborns underwent high enterostomy during neonatal period and required parenteral nutrition. There were 12 boys and 9 girls with a median age of 2 months （1 day 8 months）. During a median follow-up period of 21 （3-140） months, 15 survived and the remainder died. And 13 patients of survival group and 2 of death group had enterostomy reversal. All death group and 5 of survival group developed complications. There were significant inter-group differences according to Fisher＇s exact test （P = 0. 012）. Three patients of death group and 9 patients of survival group preserved ileoeecal valve. No statistical significance existed between two groups. The mean residual small bowel length was much shorter in death group than that in survival group [（57. 5 ± 14. 1） vs （115.9 ± 46. 7 cm） ,P = 0. 008]. No statistical significance existed in birth weight or weight-for-age on admission. Conclusions Mortality risk is greater for patients with TSBS. Shorter length of residual small bowel is associated with more complications. Both nutrition support and close follow-ups are essential.