新生儿坏死性小肠结肠炎后肠狭窄65例临床特点与外科治疗

Clinical characteristics and surgical treatment of intestinal stricture after necrotizing enterocolitis in 65 neonates

目的探讨新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)后肠狭窄的临床特点及诊治经验。方法回顾性分析湖南省儿童医院新生儿外科2013年1月至2018年1月收治的NEC后肠狭窄患儿的病例资料。结果共纳入65例NEC后肠狭窄患儿,均表现为反复腹胀、呕吐、喂养不耐受,严重者出现血便、穿孔等。其中男36例,女29例;足月儿31例,早产儿34例,胎龄29~41周;出生体重1200~4700 g。64例NEC前有喂养史;BellⅢ期15例,Ⅱ期50例。56例有输血或使用血制品史,13例有呼吸机辅助通气史。14例肠狭窄发生在回肠造瘘术后,51例无造瘘手术史;64例有1次或多次住院病史;患儿术前均常规行结肠造影或全消化道造影检查;44例为单发狭窄,17例为2处狭窄,2例为3处狭窄,2例为横结肠多发串珠样狭窄;狭窄部位包括回肠19例,升结肠17例,横结肠30例,降结肠15例,乙状结肠5例;15例行回肠造瘘术,50例行肠切除吻合术;2例出现吻合口漏,1例出现粘连性肠梗阻再次手术,3例因术后重症感染放弃治疗,治愈率95.4%(62/65)。结论NEC后反复腹胀、呕吐、喂养不耐受、特别是有输血史及喂养史的患儿需警惕肠狭窄,结肠造影为首选检查方法;病变好发于结肠,且有多发狭窄可能,多数一期行病变肠管切除肠吻合术可取得良好效果,病情危重行分期手术亦能取得满意效果。

Objective To study the clinical characteristics and treatment of post necrotizing enterocolitis(NEC)stricture in neonates.Method Post NEC infants diagnosed with intestinal strictures,admitted to our Department from January 2013 to January 2018 were studied retrospectively.Result A total of 65 infants had repeated abdominal distension,vomiting and feeding intolerance,and the severely ill infants had bloody stool,perforation,etc.Among the 65 neonates,36 were male,29 were female,31 were term infants and 34 were preterm infants.Gestational age ranged from 29~41 weeks.Birth weight ranged from 1200~4700 g.56 of them had a history of blood transfusion or use of blood products.64 cases had feeding history before the onset of NEC.Among them,there were 15 cases of Bell stageⅢand 50 cases of Bell stageⅡ.13 infants had a history of mechanical ventilation.51 cases had no fistula surgical history,intestinal stenosis in the other 14 cases occurred after ileostomy.64 patients had a history of one or more hospitalizations.Before operation,all the infants underwent routine colonography or total gastrointestinal radiography.44 patients had single stricture,17 had 2 strictures,2 had 3 strictures,and 2 had multiple beaded strictures in the transverse colon.The stricture sites were as follows,19 cases of ileum,17 cases of ascending colon,30 cases of transverse colon,15 cases of descending colon and 5 cases of sigmoid colon.15 cases were treated with ileostomy and 50 cases were treated with resection and anastomosis.Anastomotic leakage occurred in 2 cases,adhesive intestinal obstruction occurred in 1 case.Treatment was withdrawn in 3 cases due to severe postoperative infection,with a recovery rate of 95.4%(62/65).Conclusion Patients with recurrent abdominal distension,vomiting,and feeding intolerance after NEC,especially those with a history of blood transfusion and feeding,should be monitored,colonography should be performed as a priority.Most of the lesions occur in the colon,and there is a possibility of multiple strictures.One-stage resection of the diseased intestine and intestinal anastomosis can achieve good results in the majority of patients.Severe cases may benefit from staged surgery.