新生儿坏死性小肠结肠炎外科手术处理及手术预后的危险因素分析

Surgical Treatment of Neonatal Necrotizing Enterocolitis and Analysis of the Risk Factors Affecting the Prognosis

目的探讨新生儿坏死性小肠结肠炎(NEC)的外科处理以及影响手术预后的危险因素。方法收集NEC手术患儿50例,其中行肠切除+肠造瘘+腹腔冲洗引流术27例(3例自动出院后死亡),行肠切除肠吻合术+腹腔冲洗引流术6例,行单纯肠穿孔修补术5例(1例死亡),行单纯开腹冲洗引流术6例(无死亡),病情危重行剖腹探查后见全肠坏死6例(均放弃治疗后死亡)。回顾性分析患儿的病例资料,并对影响患儿预后的因素进行单因素以及多因素Logistic回归分析。结果 50例中,治愈40例,死亡10例。单因素分析结果显示,NEC手术患儿如发生代谢性酸中毒、新生儿硬肿症、发病至手术时间<1d、术前使用呼吸机、多处肠段穿孔、肠坏死广泛病变,则术后死亡率高(P<0.05)。多因素Logistic回归分析结果显示,代谢性酸中毒、发病至手术时间<1d、术前使用呼吸机、多处肠段穿孔、肠坏死广泛病变是影响NEC患儿手术预后的独立危险因素(OR=5.062～9.562,P<0.05)。结论影响NEC患儿手术预后的因素较多,如代谢性酸中毒、发病至手术时间、肠坏死广泛病变等,针对高危因素给予有效的干预措施可降低死亡率。

Objective To investigate the surgical management of neonatal necrotizing enterocolitis(NEC)and the risk factors that affect the prognosis of the operation.Methods The total of50NEC children who were admitted to our hospital in October2015-May2017were retrospectively analyzed.The data of surgical treatment and other data of these50cases were retrospectively analyzed.The univariate and multivariate Logistic regression analysis was performed on the factors affecting the prognosis of the children.Results Of the50cases,27cases underwent intestinal resection,colostomy,and peritoneal drainage.6cases underwent intestinal anastomosis plus peritoneal drainage.5cases underwent simple intestinal perforation repair(1of them died).6cases underwent laparotomy,irrigation and drainage.6cases with critical conditions underwent laparotomy after the whole intestinal necrosis(3cases died after giving up treatment,3cases voluntarily left hospital).The univariate analysis showed that NEC patients with metabolic acidosis,neonatal scleredema with time of onset to operation<1d.They experienced preoperative ventilator,multiple intestinal perforation,intestinal necrosis lesions,and their postoperative mortality was high(P<0.05).Multivariate Logistic regression analysis showed metabolic acidosis and the onset time to operation<1d,and that preoperative ventilator,multiple bowel perforation,and extensive intestinal necrosis were independent risk factors affecting the prognosis of NEC children(OR=5.062~9.562,P<0.05).Conclusion There are many factors that affect the prognosis of children with NEC,such as metabolic acidosis,onset to operation time,intestinal necrosis,and extensive lesions.Effective interventions for high-risk factors are advantageous to reduce mortality.