新生儿消化道穿孔的临床特点及预后分析

Clinical characteristics and prognosis analysis of neonatal gastrointestinal perforation

目的 分析发生消化道穿孔的新生儿临床资料,总结其临床特点及预后。方法 回顾性分析2016年8月至2021年8月郑州大学第三附属医院新生儿科收治的107例消化道穿孔新生儿临床资料,根据出生胎龄分为早产儿组与足月儿组,比较两组间的病因、临床特点、治疗及预后。结果 107例患儿中男75例,女32例;早产儿88例,足月儿19例。两组早期临床均以腹胀多见,腹片80例(74.8%)提示气腹,早产儿组、足月儿组穿孔中位日龄分别为4.0(2.0,11.0)d和3.0(2.0,6.0)d。100例行手术治疗,其中胃、小肠、大肠穿孔分别为42例、43例、14例;美克尔憩室穿孔1例;余7例未行手术治疗穿孔部位不确定。早产儿组穿孔的主要原因有新生儿坏死性小肠结肠炎、胃壁肌层发育不良、自发性肠穿孔等,足月儿组穿孔的原因主要有肠旋转不良和肠扭转、新生儿坏死性小肠结肠炎等。比较不同胎龄新生儿的穿孔部位发生率无统计学差异(P>0.05);比较不同出生体重新生儿穿孔部位发生率差异有统计学意义(P<0.05)。所有病例死亡30例(病死率28.0%);早产儿组死亡26例(病死率29.5%);足月儿组死亡4例(病死率21.1%)。结论 新生儿消化道穿孔病因多种多样,低出生体重儿易患病,回肠及胃大弯穿孔侧多见,本类疾病病死率高,需尽早诊断,积极治疗,及时外科干预。

Objective To analyze the clinical data of neonates with gastrointestinal perforation and summarize the clinical characteristics and prognosis.Methods Clinical data of 107 neonates with gastrointestinal perforation admitted to the Department of Neonatology of the Third Affiliated Hospital of Zhengzhou University from August 2016 to August 2021 were retrospectively analyzed. According to the gestational age, the neonates were divided into preterm group and full-term group, and the etiology, clinical characteristics, treatment and prognosis of the two groups were compared.Results There were 75 males and 32 females in 107 neonates with gastrointestinal perforation, including 88 premature infants and 19 full-term infants.Abdominal distension was common in both groups in the early clinical stage, and abdominal radiography indicated pneumoperitoneum in 80 cases(74.8%).The median age of perforation was 4.0(2.0,11.0) in the preterm group and 3.0(2.0,6.0)d in the full-term group.There were 100 cases of surgical treatment including 42 cases of gastric, 43 cases of small intestine, 14 cases of large intestine perforation;1 case of Meckels diverticulum perforation;And the perforation site of the remaining 7 cases was not clear because no operation was performed.The main causes of perforation in premature infants were neonatal necrotizing enterocolitis, dysplasia of gastric wall and muscularis, spontaneous intestinal perforation, etc;While the main causes of perforation in full-term infants were malrotation and vovulus of intestine, neonatal necrotizing enterocolitis, etc.There was no significant difference in the incidence of perforation at different gestational ages(P>0.05).The incidence of perforation in neonates with different birth weights was compared(P<0.05),and the difference was statistically significant.Among all the cases, 30 died(fatality rate 28.0%),26 deaths due to premature infants(fatality rate 29.5%),and 4 deaths due to full-term infants(fatality rate 21.1%).Conclusions The causes of neonatal gastrointestinal perforation are diverse, low birth weight children are prone to disease, the perforation of ileum and greater curvature of stomach is more common.The mortality is high, need early diagnosis, active treatment and timely surgical intervention.