新生儿坏死性小肠结肠炎和先天性巨结肠肠穿孔的鉴别诊断和治疗分析

Differential Diagnosis and Treatment Analysis of Neonatal Necrotizing Enterocolitis and Congenital Megacolon Intestinal Perforation

目的分析新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NCE)与先天性巨结肠肠穿孔(hirschsprung's disease,HD)的鉴别诊断与治疗措施。方法选入样本276例,均为NCE与HD患儿,根据患儿的疾病类型不同进行分组,其中NCE患儿有228例,设置为NCE组,HD患儿有48例,设置为HD组。选入样本时间为2014年1月—2019年12月,回顾性分析患儿的临床资料,包括患儿的早产儿比例、低体重儿比例、发病日龄、术前临床症状以及患儿的手术处理方法等进行比较分析,鉴别两组患儿的临床症状,同时分析患儿的治疗措施。结果两组患儿在腹胀、发热、气腹、低体温、腹壁发红以及呕吐胆汁对比指标差异无统计学意义(P>0.05);NEC组患儿的术前排便(71.49%)、黏液血便(52.19%)等发生率相比于HD组患儿(27.08%、8.33%)明显更高,且指标之间差异有统计学意义(P<0.05);总结分析患儿的术中所见与手术处理方法,两组在小肠坏死穿孔、回盲部坏死穿孔、结肠坏死穿孔方面,差异无统计学意义(P>0.05);NEC组患儿的肠管坏死长度>10 cm(100.00%)以及肠吻合(18.86%)方面相比于HD组(45.83%、0.00%)占比明显更高,互相之间对比分析,差异有统计学意义(P<0.05);NEC组患儿的肠造瘘(81.14%)比HD组(100.00%)患儿占比低,差异有统计学意义(χ^(2)=10.723,P<0.05)。结论对于HD患儿与NEC患儿来说,通常需要结合患儿的实际情况进行综合分析才能对其进行鉴别诊断,对于NEC患儿,比较建议行肠吻合术进行治疗,如果风险比较大,则改为造瘘术;HD引起的肠穿孔建议患儿接受双腔造瘘术,如果两种疾病不能准确鉴别,则可实施肠造瘘术。

Objective To analyze the differential diagnosis and treatment of neonatal necrotizing enterocolitis(NCE)and Hirschsprung's disease(HD).Methods 276 children with nce and HD were selected and grouped according to their disease types.228 children with nce were set as nce group and 48 children with HD were set as HD group.The samples were selected from January 2014 to December 2019.The clinical data of the children were retrospectively analyzed,including the proportion of premature infants,the proportion of low body weight infants,the age of onset,preoperative clinical symptoms and surgical treatment methods,so as to identify the clinical symptoms of the two groups and analyze the treatment measures of the children.Results There were no statistically significant differences in abdominal distension,fever,pneumoperitoneum,hypothermia,redness of abdominal wall and bile vomiting between the two groups(P>0.05).The incidence of preoperative defecation(71.49%)and mucous blood defecation(52.19%)in NEC group was significantly higher than that in HD group(27.08%and 8.33%),and the statistical analysis between indicators was significant(P<0.05).The results showed that there were no statistically significant differences in intestinal necrosis and perforation,ileocecal necrosis and colon perforation between the two groups(P>0.05).The rates of length of intestinal necrosis over 10 cm(100.00%)and intestinal anastomosis(18.86%)in NEC group were significantly higher than those in HD group(45.83%,0.00%),and the comparison between them was statistically significant(P<0.05).The incidence rate of enterostomy in NEC group(81.14%)was lower than that in HD group(100.00%),and the difference was statistically significant(χ^(2)=10.723,P<0.05).Conclusion For HD children and NEC children,it is usually necessary to make a comprehensive analysis in combination with the actual situation of the children in order to make a differential diagnosis.For NEC children,it is recommended to perform intestinal anastomosis for treatment.If the risk is high,it is changed to ostomy;for intestinal perforation caused by HD,it is recommended that children receive double lumen fistulation.If the two diseases cannot be accurately identified,enterostomy can be performed.