新生儿坏死性小肠结肠炎造瘘的最佳方案及关瘘时间探讨

The best treatment plan for neonatal necrotizing enterocolitis and related time

目的探讨坏死性小肠结肠炎(neonatal neerotizing enterocolitis,NEC)造瘘的最佳方案及关瘘时间。方法回顾解放军总医院第七医学中心八一儿童医院2011至2014年因NEC行肠造瘘术及二期关瘘术新生儿的临床资料。根据关瘘时间分为早期组(术后90 d内关瘘)、中期组(术后90~180 d关瘘)及晚期组(术后180 d以上关瘘)。临床资料包括出生及两次手术时孕周及体重、并发症、术后喂养及体重、静脉营养(PN)及住院天数等。结果本研究共纳入36例患儿,其中早期组8例,中期组14例,晚期组14例。三组患儿的出生及造瘘时体重、孕周差异无统计学意义(P>0.05),而关瘘时三组间体重差异有统计学意义(P<0.05)。三组造瘘术后总PN时间(P=0.000)、关瘘术后PN时间(P=0.005)、达足量肠内营养所需时间(P=0.035)、造瘘后总住院天数(P=0.019)、关瘘后住院天数(P=0.000)差异均有统计学意义;上述指标两两间对比结果显示:早、中期之间以及早、晚期之间差异均有统计学意义,而中、晚期之间差异无统计学意义。结论尽管早期组、中期组和晚期组在术后营养支持、住院时间等方面存在差异,但治疗结局都较满意。NEC造瘘术后需密切监测患儿的生长发育。生长发育稳定的患儿90 d以上关瘘是安全可行的。需早期关瘘的患儿则要做好个体化营养支持。

Objective To discuss the postoperative treatment and the optimal timing of ostomy closure for neonatal necrotizing enterocolitis(NEC)patients with enterostoma.Methods Records of patients with NEC who received a enterostomy between 2011 to 2014 in our hospital were reviewed.Patients were divided in three groups:early ostomy closure(EC,within 90 d),medium ostomy closure(MC,90-180 d)and late ostomy closure(LC,after more than 180 d).Data were colleted include the weight and gestaional age at birth,at stoma creation and at stoma reversal;postoperative complications;data about feeding;length of PN and hospitalization.Results There were 36 patients while 8 in group EC,14 in group MC and 14 in group LC.Three groups had no significantly difference in gestational age and birth weight at the time of stoma closure(P>0.05).There were significant differences in total PN time(P<0.05),postreversal PN time(P=0.005),enteral nutrition time(P=0.035),total hospitalization days(P=0.019)and postreversal hospitalization days(P=0.000)among the three groups.Inter group comparison showed that there were significant differences between EC and MC/LC,but there was no significant difference between MC and LC.Conclusion Although there were differences in length of nutritional support and hospital stay between three groups,both the outcome was satisfactory.Comprehensive treatment and monitoring of growth are needed after operation.The optimal time to take stoma closure with stable growth could be after 90 d.As for the patients indicated early ostomy closure,it is also feasible while under individual nutritional support.