新生儿胃肠穿孔206例病因分析及临床转归

Etiology and prognosis of neonatal gastrointestinal perforation： an analysis of 206 cases

目的分析新生儿胃肠穿孔的疾病种类、诊疗情况及转归，为临床提供诊治思路。方法回顾性分析2010年7月至2014年6月我院新生儿内科和新生儿外科收治的胃肠穿孔患儿的临床资料，包括性别、胎龄、体重、日龄、是否双胎、症状、体征、术前检查、术中所见、手术方式、病理结果及预后等，比较早产儿与足月儿穿孔的特点，以及不同穿孔位置、不同穿孔病因的特点。结果共纳入206例胃肠穿孔新生儿，胃穿孔46例（22．3％），肠穿孔160例（77．7％）。其中男158例，女48例；足月儿87例，早产儿119例；发病日龄7h～27d，中位数5．35d；常见症状为腹胀（96．1％）、纳差或呕吐（68．9％）、反应差（59．7％）。主要病因构成比：早产儿主要为胃壁肌层缺损、新生儿坏死性小肠结肠炎（NEC）、肠神经发育异常，足月儿主要为先天性巨结肠和NEC；胃穿孔和肠穿孔患儿的早产儿比例及足月儿和早产儿最终转归比较差异均无统计学意义（P〉0．05）。治愈或好转141例（68．4％），死亡或放弃65例（31．6％）。死亡或放弃治疗的原因主要为重症感染、延迟诊断或延迟手术导致的多器官功能衰竭，主要疾病包括NEC、肠神经发育不良、先天性巨结肠、胃壁缺损等。结论新生儿胃肠穿孔以男性、早产儿及肠穿孔更多见。出生1周内的新生儿如出现腹胀、拒乳、呕吐、血便等，应高度警惕胃肠穿孔，予以及时诊断和治疗。

Objective To study the etiology, diagnosis, treatment and prognosis of neonatal gastrointestinal perforation. Methods From July 2010 to June 2014, the medical records of neonates with gastrointestinal perforation admitted to the neonatal surgery and neonatal intensive care unit were retrospectively reviewed. Their medical records including demographic information, perioperative information and prognosis were analyzed and compared between term and preterm infants. Results Among 206 patients reviewed,158 were male and 48 female, 119 were preterm infants and 87 term infants. The average birth weight of participants was （2 500 -＋ 210）g, ranging from 960g to 5 130g. The body weight at admission was （2 410 ＋ 190）g, ranging from 940g to 5 650g. Age of onset ranged from 7 hours to 27 days （median： 5.35 days）. 141 patients were cured or had improved prognosis. 189 patients received operation, 3 patients were treated conservatively, and the other 14 patients refused to accept operative therapy. Common presentations included abdominal distension （96. 1% ）, poor appetiteor vomiting （68.9%）. The majority of causes in preterm infants included congenital absence of muscular structures of the stomach, neonatal necrotizing enterocolitis （NEC） and enteric neuronal dysplasia, while congenital megacolon and NEC in term infants. Gastric perforation group and bowel perforation group had similar preterm infants ratio and no significant differences existed on the outcomes of preterm and term infants （P 〉 0. 05 ）. Main causes of death/withdraw were severe infectionand multiple organ dysfunction resulting from delayed diagnosis or operation. Conclusion Neonatal gastrointestinal perforation occurs more commonly in males than in females. Preterm infants have higher risk developing gastrointestinal perforation. When a newborn less than one week presents with abdominal distension or vomiting, gastrointestinal perforation should be excluded first.