Cao Xuqing,Pan Xiaoxue,Shen Chun.Clinical features and outcomes of intestinal strictures after conservative measures for necrotizing enterocolitis[J].Journal of Clinical Pediatric Surgery,,():135-139.[doi:10.3760/cma.j.cn101785-202203001-007]
Clinical features and outcomes of intestinal strictures after conservative measures for necrotizing enterocolitis
- Abstract:
- Objective To summarize the clinical features of intestinal stricture after conservative measures for neonatal necrotizing enterocolitis (NEC) and compare the outcomes of single and multiple stricture groups.Methods From January 2014 to December 2020,retrospective review was performed for the relevant clinical data of 67 neonates operated for post-NEC intestinal strictures.Basic information, NEC onset time,Bell stage,radiographic studies,surgical approach postoperative complications were recorded.Then they were assigned into two groups of single stricture and multiple strictures and the prognosis between two groups were compared.Results Positive rate of preoperative contrast enema was 83.9%.Primary end-to-end anastomosis (n=60) and enterostomy (n=7) were performed at a median of 39 days after NEC with a median weight of 2.53 kg.Multiple strictures were detected in 33 neonates (49.3%) while the remainders had only 1 stricture.There were a total of 123 strictures.Except for 1 stricture spanning small intestine and colon (from terminal ileum to sigmoid colon),65 strictures were present in small intestine,including terminal ileum (n=37) and colon (n=57)(ascending colon,n=27).Two cases underwent enterostomy later due to disease deterioration and 1 died at Month 2 after discharge.Another child accepted enterostomal closure 12 months later.Complications included intestinal prolapse (n=2) and adhesive intestinal obstruction (n=4).The long-term survival rate of intestinal strictures after conservative measures was 95.5%(64/67).Length of bowel resection (P<0.001) and operative duration (P=0.008) were significantly longer in multiple-stricture group than those in single-stricture group.However,no significant inter-group difference existed in time to complete enteral feeding (P=0.862) or postoperative complications (P=0.347).Conclusions Despite a low incidence of intestinal strictures after conservative measures for NEC,multiple strictures account for a large proportion.The strictures occur predominantly in terminal ileum and colon.Contrast enema is valuable for preoperative examination.All intestinal segments should be carefully explored intraoperatively.And multiple strictures have no effect upon postoperative recovery and outcomes.
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Memo
收稿日期:2022-3-1。
基金项目:国家自然科学基金面上项目(81873849)
通讯作者:沈淳,Email:chshen0521@126.com