新生儿坏死性小肠结肠炎(附27例报告)

Neonatal Necrotizing Enterocolitis: A Report of 27 Cases

本文分析了27例新生儿坏死性小肠结肠炎患儿的临床资料,提出发病的年龄、患儿体重及围产期并发症对新生儿坏死性小肠结肠炎预后影响甚大.指出其手术指征为①全身情况恶化,②大量血便,③保守治疗超过48小时腹胀不减轻,④局限性腹膜炎.⑤腹穿镜检有大量脓球,⑥X线表现门静脉积气、肠梗阻及气腹征.其中最关键的指征为腹胀.并主张早期造瘘是有效的预防措施.

In this paper, 27 cases of neonatal necroti-zing entero-colitis treated in the neonatal surgical service from 1978 to 1984 were collected. 11 survived, 11 died and 5 cases refused treatment. Both the survival and the mortality rate were 40.7% respectively. Various factors affecting the prognosis were listed as: age, body weight, prematuriy, perinatal complications and mode of feeding The first 3 in sequence were of the most impor -tance. The cilncal symptoms, roentgenologic examination and the method of treatment were doscribed. The pathogenesis of neonatal necrotizing en-terocolitis is closely related to the following three factors, i.e., the intestinal anoxia, the invasion of bacteria and feeding by mouth. The indications of operation are: clinical deterioration, remarkable blood in stool, no relief of abdominal distension under conservative treatment for 48 hours, signs of peritonitis, positive paracentsis with pus cells, gas in port a hepatis, intestinal obstruction and pneumoperi -toneum, while the abdomina distension is the keynote for laparotomy because it is the main factor causing perforation, intestinal paralysis and toxic shock due to bacterial imbalance Th e effective measure is early enterostomy.