Huang Mingjie,Zhang Xintao,Gao Zichuan,et al.Clinical characteristics and risk factors of gastrointestinal dysfunction after infant enterostomy[J].Journal of Clinical Pediatric Surgery,,():1140-1148.[doi:10.3760/cma.j.cn101785-202509008-009]
Clinical characteristics and risk factors of gastrointestinal dysfunction after infant enterostomy
- Keywords:
- Postoperative Gastrointestinal Dysfunction; Infant; Stoma
- Abstract:
- Objective To explore the clinical characteristics and risk factors of postoperative gastrointestinal dysfunction (POGD) in infants after enterostomy. Methods From January 2019 to December 2024,perioperative clinical data were retrospectively reviewed for 216 infants undergoing enterostomy and subsequently completed secondary enterostomy closure.Using postoperative fasting time >5 day,vomiting or bile-colored fluid drainage from nasogastric tube as diagnostic criteria for POGD,they were assigned into two groups of POGD and non-POGD.Baseline profiles,intraoperative status,postoperative recovery and secondary enterostomy closure status were examined for univariate analysis.Independent factors with P<0.05 were included in a binary Logistic regression for analyzing the independent risk factors affecting the recovery of gastrointestinal function after enterostomy. Results Among them,there were 98 premature infants (45.37%).Primary diseases included necrotizing enterocolitis of newborn (NEC) (54/216,25.00%),anorectal malformation (51/216,23.61%),intestinal atresia (31/216,14.35%) and gastrointestinal perforation (69/216,31.94%).POGD group consisted of NEC (n=47) and intestinal atresia (n=24) while non-POGD group was dominated by anorectal malformation (n=44).As compared with non-POGD group,POGD group had longer operative durations,more intraoperative blood transfusions and was more frequently accompanied by poor intestinal status (e.g.edema,necrosis,perforation & adhesion).Comparisons between two groups in postoperative gastrointestinal decompression drainage ［161.00(102.50,268.00) vs. 35.00(7.00,80.00) mL］,parenteral nutrition time ［22.00(14.00,40.00) vs. 8.00(5.00,13.00) d］,length of hospitalization stay ［28.00(19.00,52.00) vs. 13.00(10.00,22.00) d］and time to initial postoperative defecation ［2.00(1.00,3.00) vs. 2.00(1.00,2.00) d］all showed statistically significant differences (P<0.05).Postoperative elevation of C-reactive protein (CRP) was more significant in POGD group (P=0.004) and infants with POGD after initial enterostomy were more likely to develop POGD after secondary enterostomy closure (36.09% vs. 8.43%).As compared with non-POGD group,POGD group after first-stage enterostomy had lower preoperative WAZ scores before secondary closure,longer operative duration,longer postoperative hospitalization stay,longer durations of parenteral nutrition and fasting and more perioperative blood transfusions (P<0.05).Multivariate Logistic regression analysis revealed that intraoperative intestinal necrosis or perforation (OR=3.671,95%CI:1.443-9.341) and primary disease (P=0.015) of NEC (OR=10.871,95%CI:2.269-52.076) or intestinal atresia (OR=7.228,95%CI:1.633-32.001) were independent risk factors for POGD after enterostomy. Conclusions Intestinal necrosis or perforation and primary disease of NEC or intestinal atresia are independent risk factors for postoperative gastrointestinal dysfunction after enterostomy.Infants with POGD after enterostomy have lower WAZ scores before secondary enterostomy closure and there is an elevated risk of developing POGD after subsequent surgery.
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Memo
收稿日期:2025-9-3。
基金项目:南京医科大学附属儿童医院高水平医院科技创新支撑计划项目(KJCXZ2024002)
通讯作者:唐维兵,Email:twbcn@njmu.edu.cn