Zhao Xiaoxia,Ma Dong,Hu Shuqi,et al.Treatment of refractory intestinal atresia and analysis of prognostic factors[J].Journal of Clinical Pediatric Surgery,2025,(07):643-646.[doi:10.3760/cma.j.cn101785-202305042-008]
难治性肠闭锁的临床特征及预后影响因素分析
- Title:
- Treatment of refractory intestinal atresia and analysis of prognostic factors
- Keywords:
- Refractory Intestinal Atresia; Nutrition; Root Cause Analysis; Surgical Procedures; Operative; Child
- 摘要:
- 目的 总结难治性肠闭锁患儿的临床特点,探讨其预后影响因素。方法 回顾性分析2015年1月至2022年12月在浙江大学医学院附属儿童医院接受治疗的难治性肠闭锁患儿临床资料,根据术后是否出现并发症、非计划二次手术或死亡,分为预后不良组(17例)与预后良好组(44例)。通过多因素Logistic回归分析筛选预后相关因素。结果 共纳入61例难治性肠闭锁患儿,病死率为6.56%(4/61),并发症发生率为21.3%(13/61),非计划二次手术率为14.8%(9/61)。预后不良组中,3例死于感染性休克(含1例 TTC7A基因突变合并免疫缺陷),1例死于坏死性肠炎。多因素Logistic回归分析显示,胎龄小(OR=2.656)、低出生体重(OR=1.576)、Ⅲb/Ⅳ型闭锁(OR=3.578)、合并其他畸形(OR=7.818)、剩余肠管长度<50 cm(OR=0.111)及肠坏死(OR=2.580)是难治性肠闭锁预后不良的独立危险因素(P＜0.05)。结论 难治性肠闭锁的预后受早产、低体重、复杂分型及肠管长度等因素影响。建议对高危患儿实施个体化手术策略(如肠管裁剪吻合或分期造瘘),这对改善预后至关重要。
- Abstract:
- Objective To explore the clinical characteristics and prognostic factors in neonates with refractory intestinal atresia (RIA). Methods A retrospective analysis was conducted for 61 RIA neonates hospitalized between January 2015 and December 2022.They were divided into two groups of poor prognosis (n=17,defined by postoperative complications,unplanned reoperations or mortality) and favorable prognosis (n=44).Prognostic factors were identified by multivariate Logistic regression analysis. Results Overall case fatality rate was 6.56%(4/61) with a complication rate of 21.3%(13/61) and unplanned reoperation rate of 14.8%(9/61).In poor prognosis group,3 deaths resulted from septic shock (including 1 case of TTC7A gene mutation and immunodeficiency) and 1 death was due to necrotizing enterocolitis.Multivariate analysis identified the following independent risk factors for poor prognosis:lower gestational age (OR=2.656),low birth weight (OR=1.576),type Ⅲb/Ⅳ atresia (OR=3.578),concurrent congenital anomalies (OR=7.818),residual small bowel length <50 cm (OR=0.111) and intestinal necrosis (OR=2.580). Conclusions Prognosis of RIA is influenced by prematurity,low birth weight,complex anatomical subtypes and residual bowel length.Individualized surgical strategies (e.g.,tailored anastomosis or staged enterostomy) are critical for optimal outcomes in high-risk neonates.
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备注/Memo
收稿日期:2023-5-26。
基金项目:浙江省自然科学基金(LY22H040006)
通讯作者:钭金法,Email:toujinfa@zju.edu.cn