新生儿坏死性小肠结肠炎肠穿孔与肠未穿孔患儿术后结局的对比研究CSCD

目的对比新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)肠穿孔与肠未穿孔患儿手术治疗后转归情况,为NEC手术时机的选择及术后治疗提供参考。方法回顾性分析2009年8月至2019年8月中国人民解放军总医院第七医学中心儿科医学部新生儿外科收治的237例经手术治疗的NEC患儿临床资料。按照是否发生肠穿孔分为肠未穿孔组(172例)与肠穿孔组(65例),收集两组患儿术中所见坏死肠管长度、手术后实施肠内及肠外营养时间、呼吸机使用时间、NICU入住时间、术后并发症以及预后情况。结果NEC肠未穿孔组172例中,治愈124例(124/172,72.1%),死亡48例(48/172,27.9%);肠穿孔组65例中,治愈48例(48/65,73.8%),死亡17例(17/65,26.2%)。两组术中所见坏死肠管长度以及术后肠外营养时间、肠内营养时间、呼吸机使用时间、NICU入住时间及术后并发症比较,差异均有统计学意义(P<0.05)。Bell分期为ⅢA与ⅢB期的患儿病死率比较,差异有统计学意义(χ^(2)=4.731,P=0.030)。结论NEC肠未穿孔的患儿可能存在更多肠管坏死,术后并发症多,康复时间长。建议对于NEC肠未穿孔患儿,可根据患儿临床实际情况探讨更合适的手术指征。

A comparative study on surgical outcome of neonatal necrotizing enterocolitis between nonperforated and perforated casesCSCD

To compare the recovery of neonatal necrotizing enterocolitis (NEC) with intestinal perforation and non-perforated bowel after surgical treatment to provide references for selecting operative timing and postoperative treatments of NEC. Methods From August 2009 to August 2019, retrospective analysis was performed for 237 children with surgical NEC. They were divided into two groups of non-perforated (n = 172) and perforated group (n = 65). Various postoperative factors (infection status, complications, enteral & parenteral nutrition time, ICU time, ventilator use time & intestinal necrosis length) were compared between two groups. Results In non-perforation group, 124 cases were cured and 48 died (48/172, 27.9%); in perforated group, 48 cases were cured and 17 died (17/65,26. 2%). Length of necrotic bowel, postoperative parenteral nutrition time, enteral nutrition time, ventilator use time, NICU stay time and postoperative complications were compared between two groups. And the difference was statistically significant (P < 0. 05). Comparison of mortality between] IIIA and IIIB groups in Bell stage (X2 = 4.731, P =0.030) and the difference was statistically significant. Conclusion Compared with perforated group, nonperforated group has longer gut necrosis. And children in non-perforated group have more serious complications and have a longer recovery time post-operation. Indications for nonperforated surgical NEC need to be further verfied. © 2022, Science and Technology Association of Hunan Province. All rights reserved.