中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2015年
2期
105-108
,共4页
王献良%邵雷朋%谢文雅%潘登%孙忠源%侯广军
王獻良%邵雷朋%謝文雅%潘登%孫忠源%侯廣軍
왕헌량%소뢰붕%사문아%반등%손충원%후엄군
小肠结肠炎,坏死性%新生儿%外科手术
小腸結腸炎,壞死性%新生兒%外科手術
소장결장염,배사성%신생인%외과수술
Enterocolitis,necrotizing%Neonate%Surgical procedures,operative
目的 探讨新生儿坏死性小肠结肠炎(NEC)的诊断及治疗方法、手术时机.方法 回顾性分析164例新生儿坏死性小肠结肠炎的临床资料.结果 164例病例中,手术72例,因肠管坏死广泛自动出院17例,占23.61％;肠造瘘41例,占56.94％,其中自动出院6例,占14.63％(4/41);因近端肠管短不适于肠造瘘而直接肠吻合14例,其中因吻合口瘘等原因自动出院5例,占35.71％(5/14).保守治疗92例,11例自动出院,占11.95％,余81例痊愈出院,其中5例因肠梗阻返院手术,均为回肠或结肠狭窄所致.全组共治愈125例,占76.22％,自动出院39例,占23.78％.其中手术组治愈44例,治愈率61.11％,保守组治愈81例,治愈率88.04％.结论 新生儿坏死性小肠结肠炎病情重,病死率高.对Bell分期Ⅰ期及部分Ⅱ期患儿,先行保守治疗;Ⅲ期患儿宜早期手术治疗.早期手术干预不一定提高治愈率;术中根据病变肠管情况选择合适手术方式:肠造瘘、肠吻合、肠内减压.
目的 探討新生兒壞死性小腸結腸炎(NEC)的診斷及治療方法、手術時機.方法 迴顧性分析164例新生兒壞死性小腸結腸炎的臨床資料.結果 164例病例中,手術72例,因腸管壞死廣汎自動齣院17例,佔23.61％;腸造瘺41例,佔56.94％,其中自動齣院6例,佔14.63％(4/41);因近耑腸管短不適于腸造瘺而直接腸吻閤14例,其中因吻閤口瘺等原因自動齣院5例,佔35.71％(5/14).保守治療92例,11例自動齣院,佔11.95％,餘81例痊愈齣院,其中5例因腸梗阻返院手術,均為迴腸或結腸狹窄所緻.全組共治愈125例,佔76.22％,自動齣院39例,佔23.78％.其中手術組治愈44例,治愈率61.11％,保守組治愈81例,治愈率88.04％.結論 新生兒壞死性小腸結腸炎病情重,病死率高.對Bell分期Ⅰ期及部分Ⅱ期患兒,先行保守治療;Ⅲ期患兒宜早期手術治療.早期手術榦預不一定提高治愈率;術中根據病變腸管情況選擇閤適手術方式:腸造瘺、腸吻閤、腸內減壓.
목적 탐토신생인배사성소장결장염(NEC)적진단급치료방법、수술시궤.방법 회고성분석164례신생인배사성소장결장염적림상자료.결과 164례병례중,수술72례,인장관배사엄범자동출원17례,점23.61％;장조루41례,점56.94％,기중자동출원6례,점14.63％(4/41);인근단장관단불괄우장조루이직접장문합14례,기중인문합구루등원인자동출원5례,점35.71％(5/14).보수치료92례,11례자동출원,점11.95％,여81례전유출원,기중5례인장경조반원수술,균위회장혹결장협착소치.전조공치유125례,점76.22％,자동출원39례,점23.78％.기중수술조치유44례,치유솔61.11％,보수조치유81례,치유솔88.04％.결론 신생인배사성소장결장염병정중,병사솔고.대Bell분기Ⅰ기급부분Ⅱ기환인,선행보수치료;Ⅲ기환인의조기수술치료.조기수술간예불일정제고치유솔;술중근거병변장관정황선택합괄수술방식:장조루、장문합、장내감압.
Objective To explore the diagnosis,treatments and operative timing of neonatal necrotizing enterocolitis (NEC).Methods Retrospective analyses were conducted for the clinical data of 164 children of NEC.Results Among 72 surgical cases,17 (23.61％) cases had an automatic discharge because of extensive bowel necrosis; among 41 (56.94％) cases of intestinal colostomy,6/ 41(14.63％) had an automatic discharge.Because of too short proximal bowel for intestinal colostomy,14 cases underwent direct anastomosis and 5/14 (35.71％) had an automatic discharge.Among 92 conservatively treated cases,11/92 (11.95 ％) had an automatic discharge.The remaining 81 cases were cured and discharged.Because of intestinal stenosis,5 cases with intestinal obstruction was readmitted for surgery.A total of 125(76.22％) cases were cured and 39 (23.78％) had an automatic discharge.Surgical cure was achieved for 44 cases with a curing rate of 61.11％.And,in the conservative group,81 cases were cured with a curing rate of 88.04％.Conclusions NEC has a high mortality with a poor prognosis.For Bell stages Ⅰ and Ⅱ NEC,conservative treatment is preferred.And early surgery is indicated for stage Ⅲ NEC.But it may not improve curing rate.Selecting an appropriate approach such as intestinal colostomy,anastomosis and enteral decompression should be based on the overall condition of bowel.
