不同病变范围新生儿坏死性小肠结肠炎手术干预效果分析

摘要

Objective To explore the surgical intervention outcomes of necrotizing enterocolitis (NEC)pa-tients with different extent of the disease.Methods The data of 25 pediatric patients with NEC who were treated with surgical intervention in Shanghai Children′s Hospital from December 201 1 to December 201 5 were retrospectively ana-lyzed.According to the extent of the disease,the patients were divided into 3 groups:focal disease(F),multisegmental disease(M),and pan -involvement(P).The information including operation style,survival rate and time for close osto-my was analyzed.Results There were 1 1 cases with F,8 cases with M,and 6 cases with P.All patients received lapa-rotomy surgery,colostomy,or peritoneal drainage.There were 1 2 patients with very low birth weight,7 patients with low birth weight,6 patients with normal birth weight in this study.There were 1 7 cases with gastrointestinal perforation (9 cases with pneumoperitoneum,8 cases without pneumoperitoneum),8 cases without digestive tract perforation (4 cases without pneumoperitoneum,4 cases with enterostenosis after conservative treatment).In this study,close ostomy was commonly conducted 3 -6 months after the operation,except for 3 cases who received 2 or more times of operation.The survival rate in F group was 1 00.0%(1 1 /1 1 cases),higher than those in the Mgroup with 62.5%(5 /8 cases)and P group with 1 6.7%(1 /6 cases)(χ2 =4.898,1 0.31 2,all P <0.05).However,there was no difference between Mgroup and P group (χ2 =1 .367,P >0.05).Conclusions The extent of disease is correlated to the outcomes of surgical in-tervention,as F had a better outcome than Mand P.Low birth weight is a risk factor for NEC.Protecting the edge of the bowel is a key factor to ensure the survival and improve the quality of life of NEC patients.Close ostomy should be con-sidered when the patients are in a stable condition (liver function and intestinal function recovery,good nutrition condi-tion,etc),and under special circumstances to conduct early or delayed closure of fistula.%目的：探讨不同病变范围新生儿坏死性小肠结肠炎（NEC）外科手术干预的效果。方法回顾性分析2011年12月至2015年12月上海市儿童医院手术治疗的25例 NEC 患儿的临床资料，根据不同肠管坏死范围分为单个坏死或穿孔的病灶（F），多发坏死或穿孔病灶（M），全肠道病变（P）3组，并对3组患儿的手术方式、术后生存率和关闭造瘘进行比较分析。结果25例患儿中，有11例为 F、8例为 M、6例为 P，均采用剖腹探查术、肠造瘘术，或仅做腹腔引流术；12例为极低出生体质量儿，7例为低出生体质量儿，6例为正常出生体质量儿。有消化道穿孔17例（9例气腹，8例无气腹），无消化道穿孔8例（4例无气腹，4例 NEC 保守治疗后肠狭窄）。3例患儿经过2次以上手术，其余患儿在造瘘术后3～6个月行造瘘关闭手术。术后生存率：F 组为100．0％（11／11例），M组为62．5％（5／8例），P 组为16．7％（1／6例）。3种病变范围中 F 组比 M组、P 组的生存率高，差异均有统计学意义（χ2＝4．898、10．312，P 均＜0．05）；M组与 P 组生存率比较差异无统计学意义（χ2＝1．367，P ＞0．05）。结论NEC 病变范围与患儿预后明显相关，F 比 M、P 的预后好，极低出生体质量儿占NEC 患儿比例较大；术中尽可能地保护边缘肠管是提高患儿存活率和生存质量的关键。造瘘关闭手术建议在造瘘术后3～6个月，待患儿肝功能、肠功能恢复、营养发育良好时进行，特殊情况建议提前或延迟关造瘘。