新生儿坏死性小肠结肠炎手术介入治疗的临床分析

Clinical analysis of surgical intervention in the treatment of necrotizing enterocolitis in neonates

摘要:

目的：评价新生儿坏死性小肠结肠炎（NEC）手术介入治疗的高危因素、预后因素及手术时机。方法：选取2001年10月至2011年10月10年间入住新生儿重症监护室的62例NEC早产儿患者。根据患儿是否需要手术治疗分为手术组（n=20）和非手术组（n=42）。比较两组患儿的一般资料、合并症、临床症状、实验室检查、治疗方法、预后等各因素。结果：呼吸窘迫综合征发生率、肠鸣音消失比例、CRP及血小板水平、血培养阳性比例、X线表现为气腹和固定肠绊及机械通气比例在两组间差异有统计学意义（P<0.05）。手术组患儿预后因素分析显示治愈患儿多处穿孔率及循环衰竭率显著低于死亡患儿，差异有统计学意义（P<0.05）。手术组20例患儿中，19例（95％）在NEC诊断后1周进行手术，15例顺利完成手术。结论：NEC手术介入治疗的高危因素是多因素的；手术的预后与肠道病变及是否循环衰竭有关。NEC手术时间一般在NEC诊断后1周内。

Abstract:

OBJECTIVE: To evaluate the high-risk factors, prognostic factors, and operation time for surgical intervention in the treatment of necrotizing enterocolitis (NEC) in neonates. METHODS: Sixty-two NEC neonates who received treatment in the neonatal intensive care unit from October 2001 to October 2011 were enrolled. Patients were assigned to surgery (n=20) and non-surgery groups (n=42). The two groups were compared with respect to general data, complications, clinical symptoms, laboratory examination results, treatment and prognosis. RESULTS: Compared with non-surgery group, the surgery group had significantly higher rates of respiratory distress syndrome, gurgling sound disappearance, C-reactive protein increase, platelet count decrease, positive blood culture, pneumoperitoneum and fixed intestinal loop on X-ray, and mechanical ventilation (P<0.05). Cured patients in the surgery group had significantly lower rates of circulation failure and multiple bowel perforations than patients who died (P<0.05), as shown by the prognostic factor analysis. Of the 20 patients in the surgery group, 19 (95%) underwent operation within one week after diagnosis of NEC and 15 survived the operation. CONCLUSIONS: There are multiple risk factors in surgical intervention for NEC. Bowel lesions and circulation failure are associated with postoperative prognosis. The operation is usually performed within one week after diagnosis of NEC.