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):372-375.[doi:10.3969/j.issn.1671-6353.2019.05.007]
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
- Title:
- Clinical characteristics of Necrotizing enterocolitis after neonatal intestinal surgery
- Keywords:
- Intestines; Small/SU; Colorectal Surgery; Enterocolitis; Necrotizing/CO; Infant; Newborn
- 分类号:
- R722.1;R574.62
- 摘要:
- 目的 对新生儿肠道手术后并发坏死性小肠结肠炎的临床特征及发病原因进行分析，探讨该病的早期诊断及治疗经验。方法 回顾性分析南京医科大学附属儿童医院2011年9月至2016年11月收治的6例肠道手术后并发坏死性小肠结肠炎患儿临床资料，6例全部为男性，平均日龄（9±11.20） d，平均体重（2.97±0.60） kg。结合各患儿的临床表现、治疗过程及治疗结局，探讨新生儿肠道手术后防止坏死性小肠结肠炎出现的治疗方案。结果 6例患儿中出现腹胀5例，便血5例，腹泻2例，发热、呕血、纳差各1例，3例合并休克；其中Bell分期Ⅱ期2例，Ⅲ期4例。4例保守治疗成功，1例保守治疗一周后腹胀、便血好转，但出现肠梗阻表现，行肠粘连松解术后治愈。1例急性期保守治疗好转，3个月后因出现升结肠狭窄接受手术治疗。结论 肠道手术后如出现便血、腹胀、腹泻、纳差、发热等症状需警惕坏死性小肠结肠炎的发生，应尽早干预，大多可通过保守治疗治愈。
- Abstract:
- Objective To explore the clinical features and causes of necrotizing enterocolitis (NEC) after neonatal intestinal surgery and explore its early diagnosis and treatment experience.Methods A retrospective analysis was conducted for 6 hospitalized NEC children after intestinal surgery from September 2011 to November 2016.Their clinical manifestations,treatments and outcomes were analyzed for formulating treatment options for preventing NEC after neonatal intestinal surgery.Results There were abdominal distension (n=5),melena (n=5),diarrhea (n=2),fever,hematemesis & anorexia (n=1) and shock (n=3).And Bell stages were Ⅱ (n=2) and Ⅲ (n=4).Four cases of conservative treatment were successful.After 1-week conservative treatment,abdominal distension and melena improved.However,intestinal obstruction was cured after loosening intestinal adhesion.One case of conservative treatment improved in acute phase and surgery was performed after 3 months due to ascending colon stenosis.Conclusion In events of such symptoms as melena,abdominal distension,diarrhea,anorexia and fever after intestinal surgery,clinicians should stay on a high alert for the occurrence of NEC.Intervention should be performed as soon as possible and most cases may be cured conservatively.
参考文献/References:
1 Goudoever HV,陈超,张蓉.新生儿坏死性小肠结肠炎的热点问题[J].中国循证儿科杂志,2011,6(5):321-323.DOI:10.3969/j.issn.1673-5501.2011.05.001.Goudoever HV,Chen Chao,Zhang Rong.Hot issues of neonatal necrotizing enterocolitis[J].Chinese Journal of Evidence-Based Pediatrics,2011,6(5):321-323.DOI:10.3969/j.issn.1673-5501.2011.05.001.
2 冯杰雄.美国新生儿坏死性小肠结肠炎研究现状[J].中华小儿外科杂志,2006,27(7):386-387.DOI:10.3760/cma.j.issn.0253-3006.2006.07.015.Feng JX.Research status of neonatal necrotizing enterocolitis in the United States[J].Chinese Journal of Pediatric Surgery,2006,27(7):386-387.DOI:10.3760/cma.j.issn.0253-3006.2006.07.015.
3 陈超.新生儿坏死性小肠结肠炎的临床问题及防治策略[J].中华儿科杂志,2013,51(5):321-325.DOI:10.3760/cma.j.issn.0578-1310.2013.05.001.Chen C.Clinical problems and prevention strategies of neonatal necrotizing enterocolitis[J].Chinese Journal of Pediatrics,2013,51(5):321-325.DOI:10.3760/cma.j.issn.0578-1310.2013.05.001.
4 唐维兵,刘翔,耿其明,等.新生儿坏死性小肠结肠炎的手术指征探讨[J].中华小儿外科杂志,2015,36(2):100-104.DOI:10.3760/cma.j.issn.0253-3006.2015.02.006.Tang WB,Liu X,Geng QM,et al.Indications of surgical treatment for necrotizing enterocolitis[J].Chinese Journal of Pediatric Surgery,2015,36(2):100-104.DOI:10.3760/cma.j.issn.0253-3006.2015.02.006.
5 Markel TA,Crisostomo PR,Wairiuko GM,et al.Cytokines in necrotizing enterocolitis[J].Shock,2006,25(4):329-337.DOI:10.1097/01.shk.0000192126.33823.87.
6 侯龙龙,李仲荣,黄璜,等.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(5):396-400.DOI:10.3969/j.issn.1671-6353.2014.05.008.Hou LL,Li ZR,Huang H,et al.Prognostic factors of neonatal necrotizing enterocolitis[J].J Clin Ped Sur,2014,13(5):396-400.DOI:10.3969/j.issn.1671-6353.2014.05.008.
7 Neu J,Walker WA.Necrotizing enterocolitis[J].N Engl J Med,2011,364(3):255-264.DOI:10.1056/NEJMra1005408.
8 Moons KG,Royston P,Vergouwe Y,et al.Prognosis and prognostic research:what,why,and how?[J].BMJ,2009,338(7706):1317-1320.DOI:10.1136/bmj.b375.
9 Borthakur A,Bhattacharyya S,Alrefai WA,et al.Platelet-activating factor-induced NF-kappa B activation and IL-8 production in intestinal epithelial cells are Bcl10-dependent[J].Inflamm Bowel Dis,2010,16(4):593-603.DOI:10.1002/ibd.21092.
10 Maynard AA,Dvorak K,Khallova L,et al.Epidermal growth factor reduces autophagy in intestinal epithelium and in the rat model of necrotizing enterocolitis[J].Am J Physiol Gastrointest Liver Physiol,2010,299(3):614-622.DOI:10.1152/ajpgi.00076.2010.
11 晏俪鸶,余加林.新生儿坏死性小肠结肠炎发病原因及预后研究进展[J].国际儿科学杂志,2016,43(6):470-473.DOI:10.3760/cma.j.issn.1673-4408.2016.06.012.Yan LS,Yu JL.Research advances in the pathogenesis and prognosis of neonatal necrotizing enterocolitis[J].International Journal of Pediatrics,2016,43(6):470-473.DOI:10.3760/cma.j.issn.1673-4408.2016.06.012.
12 Kliegman RM,Hack M,Jones P,et al.Epidemiologic study of necrotizing enterocolitis among low-birth-weight infants.Absence of identifiable risk factors[J].Journal of Pediatrics,1982,100(3):440-444.
13 刘淼清,王永飚,李仲荣,等.45例新生儿坏死性小肠结肠炎的诊疗体会[J].临床小儿外科杂志,2010,9(1):76-77.DOI:10.3969/j.issn.1671-6353.2010.01.034.Liu MQ,Wang YB,Li ZR,et al.Diagnosis and treatment of neonatal necrotizing enterocolitis:a report of 45 cases[J].J Clin Ped Sur,2010,9(1):76-77.DOI:10.3969/j.issn.1671-6353.2010.01.034.
14 Gephart SM,McGrath JM,Effken JA,et al.Necrotizing enterocolitis risk:state of the science[J].Adv Neonatal Care,2012,12(2):77-87.DOI:10.1097/ANC.0b013e31824cee94.
15 Gagliardi L,Bellu R,Cardilli V,et al.Necrotising enterocolitis in very low birth weight infants in Italy:incidence and non-nutritional risk factors[J].J Pediatr Gastroenterol Nutr.2008,47(2):206-210.DOI:10.1097/MPG.0b013e318174e855.
16 Kamoji VM,Dorling JS,Manktelow B,et al.Antenatal umbilical Doppler abnormalities:an independent risk factor for early onset neonatal necrotizing enterocolitis in premature infants[J].Acta Paediatr,2008,97(3):327-331.DOI:10.1111/j.1651-2227.2008.00671.x.
17 Gregory KE.Clinical predictors of necrotizing enterocolitis in premature infants[J].Nurs Res,2008,57(4):260-270.DOI:10.1097/01.NNR.0000313488.72035.a9.
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备注/Memo
收稿日期:2018-01-14。
通讯作者:陈焕,Email:1933258744@qq.com