儿童急性坏死性肠炎并肠穿孔的特点和手术方式选择

Characteristics of acute necrotizing enteritis with bowel perforation and selection of surgical methods

目的探讨儿童急性坏死性肠炎(acute necrotizing enteritis ANE)并肠穿孔的临床特点和手术方法。方法回顾性分析2008年1月—2019年12月在本院进行手术治疗13例ANE并肠穿孔患儿的临床资料,总结分析患者肠穿孔的特点和手术方法。结果 13例患儿中单处穿孔8例,分别位于十二指肠1例,空肠5例,回肠2例;多处穿孔5例,其中穿孔灶2~3处4例,72处1例,散在分布于空肠及回肠。穿孔直径0.2~0.8 cm。13例患儿中行肠穿孔修补8例,肠切除肠吻合4例,单纯腹腔引流1例。除1例合并复杂先天性心脏病患儿死亡,其余均顺利康复出院,并获随访1~3年,恢复良好。结论儿童急性坏死性肠炎并肠穿孔发病前多有腹泻表现。穿孔肠管病变多较局限。术中宜根据具体情况采取个体化的手术方案,实施一期手术安全可行。

Objective To explore the clinical features and operative approaches of acute necrotizing enteritis(ANE) with bowel perforation.Methods The clinical data of 13 surgical cases of ANE complicated with intestinal perforation those treated in our hospital from January 2008 to October 2019 were retrospectively analyzed.Results Ten patients had a history of unclean diet,11 cases had a history of preoperative diarrhea.There were 8 cases of single perforation,including duodenum(n=1),jejunum(n=5),and ileum(n=2);5 cases of multiple perforation,and 4 cases with 2 to 3 perforation lesions and one cases even with 72 perforation lesions,the perforation lesions scattered in the jejunum and ileum,and their diameters ranged from 2 to 8 millimeter.In this group of cases,8 cases underwent primary anastomosis,4 cases of intestinal resection&anastomosis,and a case of peritoneal drainage.Except for one death case with congenital heart disease,all others recovered smoothly and were followed up for one to three years.Conclusions Most children present diarrhea before onset of ANE.The lesions of perforated intestine are mostly limited.Operations for ANE with bowel perforation should be individualized.Phase I operation safety is often plausible.