摘要
目的探讨不同手术年龄新生儿坏死性小肠结肠炎(NEC)手术治疗的效果。方法选取2014年1月至2017年12月本院105例NEC手术患儿的临床资料,根据手术年龄分为早期手术组(手术年龄≤7 d,n=47)和晚期手术组(7 d <手术年龄≤28 d,n=58),比较两组的一般资料、手术指征、术中情况、手术方式、术后并发症和术后生存率。结果 105例NEC患儿中,男74例,女31例,出生体重(2 398±927) g,出生孕周(35±4)周。与早期手术组相比,晚期手术组患儿出生体重更轻、孕周更小、合并呼吸衰竭率更高(均P <0. 05)。两组各手术指征(弥漫性腹膜炎、气腹和内科治疗无效)所占比例的差异无统计学意义(P> 0. 05)。晚期手术组小肠坏死率高于早期手术组,但小肠结肠坏死率和结肠坏死率均低于早期手术组,差异有统计学意义(P <0. 05)。两组各手术方式(肠造瘘术、肠切除肠吻合+肠造瘘术、剖腹探查术、腹腔引流术和肠切除肠吻合术)所占比例的差异无统计学意义(P> 0. 05)。早期手术组肠狭窄的发生率高于晚期手术组,差异有统计学意义(P <0. 05)。早期手术组术后生存率为78. 7%,而晚期手术组术后生存率为63. 8%,差异无统计学意义(P> 0. 05)。结论出生1周内手术的NEC患儿多见于足月儿,结肠坏死常见,术后容易出现肠狭窄。出生1周后手术的NEC患儿多见于早产儿和低体重儿,常伴有呼吸衰竭。气腹和弥漫性腹膜炎是NEC常见的手术指征。肠造瘘术是最主要的手术方法,选择合适的手术时机和手术方式能够改善NEC患儿的预后。
Objective To investigate the effect of surgical treatment of necrotizing enterocolitis (NEC) with different surgical ages.Methods From January 2014 to December 2017,105 neonates with NEC in our hospital were divided into early operation group (operation age < 7 days,n =47) and late operation group (7 < operation age < 28 days,n =58).The general data,surgical indications,intraoperative conditions,surgical methods,postoperative complications,and postoperative survival rates were compared between the two groups.Results Among the 105 neonates with NEC,74 were male and 31 were female.The average birth weight was (2 398 ± 927)g,and the average gestational age was (35 ± 4)weeks.Compared with the early operation group,the late operation group had lighter birth weight,smaller gestational age and higher rate of respiratory failure (P < 0.05).There was no significant difference between the two groups in the proportion of surgical indications (diffuse peritonitis,pneumoperitoneum,and medical treatment ineffective) (P > 0.05).The necrosis rate of small intestine in the late operation group was higher than that in the early operation group,but the necrosis rate of small intestine and colon was lower than that in the early operation group (P < 0.05).There was no significant difference in the proportions of the two groups in the surgical methods (enterostomy,intestinal resection and anastomosis and enterostom,exploratory laparotomy,abdominal drainage,and intestinal resection and anastomosis) (P > 0.05).The incidence of intestinal stenosis in early operation group was higher than that in late operation group (P < 0.05).The survival rate of early operation group was 78.7%,while that of late operation group was 63.8%,with no significant difference (P > 0.05).Conclusions The patients with NEC who were operated within 1 week after birth are more common in term infants and with colon necrosis,and are more likely to occur intestinal stenosis after surgery.The patients with NEC who were operated after 1 week of birth are more common i
作者
许光
周崇高
王海阳
邹婵娟
夏仁鹏
赵凡
马体栋
李碧香
Xu Guang;Zhou Chonggao;Wang Haiyang;Zou Chanjuan;Xia Renpeng;Zhao Fan;Ma Tidong;Li Bixiang(Department of Neonatal Surgery,Hunan Children's Hospital,Changsha 410007,China)
出处
《中国医师杂志》
CAS
2018年第11期1656-1659,共4页
Journal of Chinese Physician
