Du Jingbin,Chen Yongwei,Guo Weihong,et al.Retrospectivestudy of indications for surgical intervention inneonatal necrotizingenterocolitis[J].Journal of Clinical Pediatric Surgery,2019,18(05):368-371.[doi:10.3969/j.issn.1671-6353.2019.05.006]
新生儿坏死性小肠结肠炎手术干预指征的回顾性研究
- Title:
- Retrospectivestudy of indications for surgical intervention inneonatal necrotizingenterocolitis
- Keywords:
- Enterocolitis; Necrotizing/SU; Infant; Newborn; Retrospective Studies
- 分类号:
- R722.1;R574.62
- 摘要:
- 目的 探讨不同的手术干预方案对新生儿坏死性小肠结肠炎（necrotizing enterocolitis，NEC）预后的影响，并初步制定NEC的手术干预指征。方法 回顾性分析北京儿童医院2006年1月至2016年1月间收治的340例NEC患儿临床资料，根据本院NEC手术指征变化情况分为前期组（2006年1月至2011年1月，仅有绝对手术指征）和后期组（2011年1月至2016年1月，在绝对手术指征的基础上添加相对手术指征），同时按照不同的治疗方式及Bell分期将前期组、后期组分别拆分出不同的亚组，并比较手术指征变化前后的患儿手术率、存活率差异。结果 340例患儿中前期组共96例，后期组共244例。前期组手术率为17.7%，后期组手术率为22.5%，两组间差异无统计学意义（P>0.05）。前期组总存活率为75.0%，后期组为86.9%，差异有统计学意义（P<0.05）；前期组中手术组存活率为47.1%，后期组中手术组存活率为74.5%，存活率显著提高（P<0.05）。后期组Bell（Ⅱ）期的手术率较前期组大幅度提高（P<0.05）；而Bell（Ⅲ）期的手术率无明显变化（P>0.05），手术指征变化后Bell（Ⅱ）、（Ⅲ）期的手术存活率未见明显提高（P>0.05）。结论 除存在气腹、完全性肠梗阻、超声检查下肠坏死等绝对手术指征外，新生儿科医师应在NEC早期密切观察病情的进展，提高临床综合判断能力，对手术指征进行个体化调整。
- Abstract:
- Objective To explore the effects of different surgical intervention indications on the prognosis of neonatal necrotizing enterocolitis (NEC). Methods From January 2006 to January 2016, retrospective analysis was performed for clinical data of 340 NEC children according to the changes of surgical indications of NEC. Absolute surgical indications in early group (from January 2006 to January 2011) and absolute and relative surgical indications in late group (from January 2011 to January 2016) were designated according to different treatment methods and Bell staging The early and late groups were split into different subgroups. And the differences in surgical and survival rates were compared before and after the changes of surgical indications. Results There were 96 cases in middle/early stage and 244 cases in late stage. The operative rate was 17.7% in early group and 22.5% in late group (P>0.05). The overall survival rate was 75.0% in pre-stage group and 86.9% in late group and overall survival rate significantly increased (P<0.05). The survival rate of operative group was 47.1% in early group and 74.5% in late group (P<0.05). The operative rate of Bell(Ⅱ) was significantly higher in late group than that in previous group (P<0.05). No significant change occurred in operative rate during Bell(Ⅲ) period (P>0.05). The survival rate after altered surgical indication showed no obvious improvements(P>0.05).Conclusion Besides pneumoperitoneum, complete intestinal obstruction, ultrasonic examination of intestinal necrosis and other absolute surgical indications, neonatologists should closely observe the disease progress during an early stage of NEC, improve the ability of comprehensive clinical judgment and individualize adjustment of surgical indications.
参考文献/References:
1 Bell MJ,Ternberg JL,Feigin RD,et al.Neonatal necrotizing enterocolitis.Therapeutic decisions based upon clinical staging[J].Annals of Surgery,1978,187(1):1-7.DOI:10.1097/00000658-197801000-00001.
2 Walsh MC,Kliegman RM.Necrotizing enterocolitis:treatment based on staging criteria[J].Pediatric Clinics of North America,1986,33(1):179-201.DOI:10.1016/s0031-3955(16)34975-6.
3 张金哲.张金哲小儿外科学[M].北京人民卫生出版社,2013,1074-1075.Zhang JZ.Pediatric Surgery[M].Beijing People’s Medical Publishing House,2013,1074-1075.
4 Jr OJ,Stahlman MT,Meng HC.Necrotizing enterocolitis in the newborn:operative indications[J].Annals of Surgery,1975,182(3):274-279.DOI:10.1097/00006254-197604000-00012.
5 秦嘉丽.新生儿坏死性小肠结肠炎诊断进展[J].重庆医学,2012,41(19):1991-1993.DOI:10.3969/j.issn.1671-8348.2012.19.041.Qin JL.Progress in diagnosis of neonatal necrotizing enterocolitis[J]Chongqing Medical Journal.2012,41(19):1991-1993.DOI:10.3969/j.issn.1671-8348.2012.19.041.
6 Eltayeb AA,Mostafa MM,Ibrahim NH,et al.The role of surgery in management of necrotizing enterocolitis[J].International Journal of Surgery,2010,8(6):458-461.DOI:10.1016/j.ijsu.2010.06.005.
7 Kosloske AM,Papile LA,Burstein J.Indications for operation in acute necrotising enterocolitis of the neonate[J].Surgery,1980,87(5):502-508.
8 安瑶,李禄全.新生儿坏死性小肠结肠炎手术指征的研究进展[J].发育医学电子杂志,2017,2(2):118-121,DOI:10.3969/j.issn.2095-5340.2017.02.015.An Y,Li LQ.Advances in surgical indications for neonatal necrotizing enterocolitis[J].Journal of Developmental Medicine,2017(2):118-121.DOI:10.3969/j.issn.2095-5340.2017.02.015.
9 Buras R,Guzzetta P,Avery G,et al.Acidosis and hepatic portal venous gas:indications for surgery in necrotizing enterocolitis[J].Pediatrics,1986,78(2):273-277.
10 Neu J.Neonatal necrotizing enterocolitis:An update[J].Acta Paediatr Suppl,2010,94(s449):100-105.DOI:10.1111/j.1651-2227.2005.tb02163.x.
11 Guner Y S,Chokshi N,Petrosyan M,et al.Necrotizing enterocolitis-bench to bedside:novel and emerging strategies.[J].Seminars in Pediatric Surgery,2008,17(4):255-265.DOI:10.1053/j.sempedsurg.2008.07.004.
12 Coursey CA,Hollingsworth CL,Wriston C,et al.Radiographic predictors of disease severity in neonates and infants with necrotizing enterocolitis.[J] American Journal of Roentgenology,2009,193(5):1408-1413.DOI:10.2214/ajr.08.2306.
13 Tepas JJ 3rd,Sharma R,Leaphart C L,et al.Timing of surgical intervention in necrotizing enterocolitis can be determined by trajectory of metabolic derangement[J].Journal of Pediatric Surgery,2010,45(2):313-314.DOI:10.1016/j.jpedsurg.2009.10.069.
相似文献/References:
[1]侯龙龙 李仲荣 黄璜. 新生儿坏死性小肠结肠炎预后相关因素分析[J].临床小儿外科杂志,2014,13(05):396.
[2]史婧奕,吕志宝.. 双歧杆菌三联活菌散预防早产儿坏死性小肠结肠炎的临床初探[J].临床小儿外科杂志,2016,15(01):72.
[3]潘登,王献良,邵雷朋..新生儿坏死性小肠结肠炎经回肠造瘘术后远端肠闭锁7例[J].临床小儿外科杂志,2016,15(05):513.
[4]臧婧羽,袁小建,程思旸,等.单中心不同手术方式治疗全结肠型巨结肠疗效分析[J].临床小儿外科杂志,2018,17(02):106.
Zang Jingyu,Yuan Xiaojian,Cheng Siyang,et al.The efficacy analysis of different operative methods in treating Total Colonic Aganglionosis (TCA) in a Single Center.[J].Journal of Clinical Pediatric Surgery,2018,17(05):106.
[5]吴书清,钟斌,刘辉,等. Bishop-Koop 造瘘术和双口造瘘术在新生儿坏死性小肠结肠炎中的疗效比较[J].临床小儿外科杂志,2018,17(11):835.
Wu Shuqing,Zhong Bin,Liu Hui,et al. Comparison of therapeutic efficacies of BishopKoop stoma versus double mouth enterostomy for neonatal necrotizing enterocolitis.[J].Journal of Clinical Pediatric Surgery,2018,17(05):835.
[6]施诚仁.再谈先天性巨结肠小肠结肠炎的防治[J].临床小儿外科杂志,2019,18(05):348.[doi:10.3969/j.issn.1671-6353.2019.05.002]
Shi Chengren.Re-discussion on prevention and treatment of congenital megacolon enterocolitis[J].Journal of Clinical Pediatric Surgery,2019,18(05):348.[doi:10.3969/j.issn.1671-6353.2019.05.002]
[7]吕志宝,盛庆丰.新生儿坏死性小肠炎的病因与诊治研究进展[J].临床小儿外科杂志,2019,18(05):352.[doi:10.3969/j.issn.1671-6353.2019.05.003]
Lv Zhibao,Sheng Qingfeng.Advances in the etiology, diagnosis and treatment of neonatal necrotizing enterocolitis[J].Journal of Clinical Pediatric Surgery,2019,18(05):352.[doi:10.3969/j.issn.1671-6353.2019.05.003]
[8]安宗剑,孙勇.新生儿肠道菌群与坏死性小肠结肠炎发病关系的研究进展[J].临床小儿外科杂志,2019,18(05):356.[doi:10.3969/j.issn.1671-6353.2019.05.004]
An Zongjian,Sun Yong.Research advances of neonatal intestinal microbiome and necrotising enterocolitis[J].Journal of Clinical Pediatric Surgery,2019,18(05):356.[doi:10.3969/j.issn.1671-6353.2019.05.004]
[9]梁琼鹤,蒋维维,路长贵,等.新生儿肠道手术后并发坏死性小肠结肠炎的临床特征分析[J].临床小儿外科杂志,2019,18(05):372.[doi:10.3969/j.issn.1671-6353.2019.05.007]
Liang Qionghe,Jiang Weiwei,Lu Changgui,et al.Clinical characteristics of Necrotizing enterocolitis after neonatal intestinal surgery[J].Journal of Clinical Pediatric Surgery,2019,18(05):372.[doi:10.3969/j.issn.1671-6353.2019.05.007]
[10]陈发玲,徐伟珏,黄雄,等.一期肠切除肠吻合术治疗新生儿坏死性小肠结肠炎后肠狭窄[J].临床小儿外科杂志,2020,19(11):1016.[doi:10.3969/j.issn.1671-6353.2020.11.011]
Chen Faling,Xu Weijue,Huang Xiong,et al.Experience of treatment of intestinal stenosis after one-stage intestinal resectional anastomosis for neonatal necrotizing enterocolitis[J].Journal of Clinical Pediatric Surgery,2020,19(05):1016.[doi:10.3969/j.issn.1671-6353.2020.11.011]
[11]郑泽兵,刘远梅,张帆,等.降钙素原、白细胞介素6、C反应蛋白在新生儿坏死性小肠结肠炎手术时机选择中的应用价值研究[J].临床小儿外科杂志,2019,18(05):361.[doi:10.3969/j.issn.1671-6353.2019.05.005]
Zheng Zebing,Liu Yuanmei,Zhang Fan,et al.Applicable value of operative opportunity for procalcitonin, interleukin-6 and C-reactive protein in neonatal necrotizing enterocolitis[J].Journal of Clinical Pediatric Surgery,2019,18(05):361.[doi:10.3969/j.issn.1671-6353.2019.05.005]
[12]汪健.新生儿坏死性小肠结肠炎研究新进展[J].临床小儿外科杂志,2022,21(04):301.[doi:10.3760/cma.j.cn101785-202203032-001]
Wang Jiang.Neonatal necrotizing enterocolitis:advances and challenges[J].Journal of Clinical Pediatric Surgery,2022,21(05):301.[doi:10.3760/cma.j.cn101785-202203032-001]
[13]张志波.新生儿坏死性小肠结肠炎:从Bell分期解读到手术指征的把握[J].临床小儿外科杂志,2022,21(04):306.[doi:10.3760/cma.j.cn101785-202201045-002]
Zhang Zhibo.Necrotizing enterocolitis:From an interpretation of Bell staging to an identification of indications for acute surgery[J].Journal of Clinical Pediatric Surgery,2022,21(05):306.[doi:10.3760/cma.j.cn101785-202201045-002]
[14]林土连,吴强,彭艳芬,等.新生儿坏死性小肠结肠炎肠造瘘术后造口高流量腹泻的相关因素分析[J].临床小儿外科杂志,2022,21(04):310.[doi:10.3760/cma.j.cn101785-202201058-003]
Lin Tulian,Wu Qiang,Peng Yanfen,et al.Risk factors of high-output stoma after enterostomy in necrotizing enterocolitis[J].Journal of Clinical Pediatric Surgery,2022,21(05):310.[doi:10.3760/cma.j.cn101785-202201058-003]
[15]苏朋俊,张志波.早产儿广泛坏死型坏死性小肠结肠炎的临床特点及相关因素分析[J].临床小儿外科杂志,2022,21(04):315.[doi:10.3760/cma.j.cn101785-202201059-004]
Su Pengjun,Zhang Zhibo.Clinical characteristics and risk factors of extensive necrotizing enterocolitis in preterm infants[J].Journal of Clinical Pediatric Surgery,2022,21(05):315.[doi:10.3760/cma.j.cn101785-202201059-004]
[16]夏仁鹏,邹婵娟,赵凡,等.新生儿坏死性小肠结肠炎肠狭窄相关因素分析[J].临床小儿外科杂志,2022,21(04):320.[doi:10.3760/cma.j.cn101785-202109042-005]
Xia Renpeng,Zou Chanjuan,Zhao Fan,et al.Analysis of risk factors for intestinal stenosis after neonatal necrotizing enterocolitis[J].Journal of Clinical Pediatric Surgery,2022,21(05):320.[doi:10.3760/cma.j.cn101785-202109042-005]
[17]马亚,王峥嵘,刘琴,等.超声检查对新生儿坏死性小肠结肠炎手术决策的意义探讨[J].临床小儿外科杂志,2022,21(04):325.[doi:10.3760/cma.j.cn101785-202111057-006]
Ma Ya,Wang Zhengrong,Liu Qin,et al.Role of ultrasound in surgical decision making for neonatal necrotizing enterocolitis[J].Journal of Clinical Pediatric Surgery,2022,21(05):325.[doi:10.3760/cma.j.cn101785-202111057-006]
[18]韩金宝,余梦楠,刘钢,等.新生儿坏死性小肠结肠炎肠穿孔与肠未穿孔患儿术后结局的对比研究[J].临床小儿外科杂志,2022,21(06):530.[doi:10.3760/cma.j.cn101785-202007046-006]
Han Jinbao,Yu Mengnan,Liu Gang,et al.A comparative study on surgical outcome of neonatal necrotizing enterocolitis between nonperforated and perforated cases[J].Journal of Clinical Pediatric Surgery,2022,21(05):530.[doi:10.3760/cma.j.cn101785-202007046-006]
备注/Memo
收稿日期:2018-10-21。
通讯作者:陈永卫,Email:yongwei1964@126.com