新生儿肠道手术后并发坏死性小肠结肠炎的临床特征分析

Clinical characteristics of Necrotizing enterocolitis after neonatal intestinal surgery

目的对新生儿肠道手术后并发坏死性小肠结肠炎的临床特征及发病原因进行分析,探讨该病的早期诊断及治疗经验。方法回顾性分析南京医科大学附属儿童医院2011年9月至2016年11月收治的6例肠道手术后并发坏死性小肠结肠炎患儿临床资料,6例全部为男性,平均日龄(9±11.20)d,平均体重(2.97±0.60)kg。结合各例患儿的临床表现、治疗过程及治疗结局,探讨新生儿肠道手术后防止坏死性小肠结肠炎出现的治疗方案。结果6例患儿中出现腹胀5例,便血5例,腹泻2例,发热、呕血、纳差各1例,3例合并休克;其中Bell分期Ⅱ期2例,Ⅲ期4例。4例保守治疗成功,1例保守治疗一周后腹胀、便血好转,但出现肠梗阻表现,行肠粘连松解术后治愈。1例急性期保守治疗好转,3个月后因出现升结肠狭窄接受手术治疗。结论肠道手术后如出现便血、腹胀、腹泻、纳差、发热等症状需警惕坏死性小肠结肠炎的发生,应尽早干预,大多可通过保守治疗治愈。

Objective To explore the clinical features and causes of necrotizing enterocolitis(NEC)after neonatal intestinal surgery and explore its early diagnosis and treatment experience.Methods A retrospective analysis was conducted for 6 hospitalized NEC children after intestinal surgery from September 2011 to November 2016.Their clinical manifestations,treatments and outcomes were analyzed for formulating treatment options for preventing NEC after neonatal intestinal surgery.Results There were abdominal distension(n=5),melena(n=5),diarrhea(n=2),fever,hematemesis&anorexia(n=1)and shock(n=3).And Bell stages wereⅡ(n=2)andⅢ(n=4).Four cases of conservative treatment were successful.After 1-week conservative treatment,abdominal distension and melena improved.However,intestinal obstruction was cured after loosening intestinal adhesion.One case of conservative treatment improved in acute phase and surgery was performed after 3 months due to ascending colon stenosis.Conclusion In events of such symptoms as melena,abdominal distension,diarrhea,anorexia and fever after intestinal surgery,clinicians should stay on a high alert for the occurrence of NEC.Intervention should be performed as soon as possible and most cases may be cured conservatively.