新生儿坏死性小肠结肠炎84例手术疗效分析

Surgical outcome of neonates with necrotizing enterocolitis:An analysis of 84 cases

目的分析我院行手术治疗的新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)患儿的诊疗资料,为临床最佳手术时机和手术方式的选择提供参考。方法回顾性分析2015年1月-2020年12月本院收治的84例NEC患儿的临床资料,所有患儿均行腹部平片检查,术中根据患儿肠管坏死部位及范围行肠造瘘术或坏死肠管切除肠吻合术,对患儿饮食、排便及体质量变化情况进行随访,并对患儿的手术治疗效果进行总结。结果84例患儿中,行肠减压腹腔引流术者2例;行肠造瘘术者72例,其中回肠造瘘67例,空肠远端造瘘5例;行坏死肠管切除肠吻合术者7例;放弃治疗者3例。患儿预后良好77例;预后不良2例,系因短肠综合征术后需定期静脉营养支持;死亡2例,系术后6个月因坏死性肠炎死亡;放弃治疗3例,因系术中发现广泛肠坏死。结论新生儿坏死性小肠结肠炎病死率高,肠造瘘是其目前的主要治疗方式,及时行手术治疗对NEC患儿具有良好的治疗效果。

Objective To investigate the diagnosis and treatment data of neonates with necrotizing enterocolitis(NEC)undergoing surgical treatment in our hospital,and to provide a reference for the selection of optimal surgical timing and approach in clinical practice.Methods A retrospective analysis was performed for the clinical data of 84 neonates with NEC who were admitted to our hospital from January 2015 to December 2020,and all neonates underwent plain abdominal radiography.During the surgery,enterostomy or resection of the necrotic intestinal canal followed by intestinal anastomosis was performed according to the location and extent of necrotic intestinal canal.The neonates were followed up to observe the changes in diet,defecation,and body weight,and their surgical outcome was summarized.Results Among the 84 neonates,2 underwent intestinal decompression and peritoneal drainage;72 underwent enterostomy,among whom 67 underwent ileostomy and 5 underwent distal jejunostomy;7 underwent resection of the necrotic intestinal canal followed by intestinal anastomosis;3 were withdrawn from treatment.Of all neonates,77 had good prognosis;2 had poor prognosis and required regular parenteral nutrition support due to short bowel syndrome;2 died of necrotic enteritis at 6 months after surgery;3 were withdrawn from treatment due to extensive bowel necrosis observed during surgery.Conclusion Neonates with NEC tend to have a high mortality rate,and enterostomy is the main treatment method at present.Timely surgical treatment has a good therapeutic effect on children with NEC.