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,2025,(12):1140-1148.[doi:10.3760/cma.j.cn101785-202509008-009]
婴儿肠造瘘手术后胃肠功能障碍的临床特点及危险因素分析
- Title:
- Clinical characteristics and risk factors of gastrointestinal dysfunction after infant enterostomy
- Keywords:
- Postoperative Gastrointestinal Dysfunction; Infant; Stoma
- 摘要:
- 目的 探讨婴儿肠造瘘手术后胃肠功能障碍(postoperative gastrointestinal dysfunction,POGD)的临床特点及危险因素。方法 回顾性分析2019年1月至2024年12月于南京医科大学附属儿童医院接受肠造瘘手术,并已完成二期肠造瘘闭合手术婴儿的围手术期临床资料。以术后禁食时间超过5 d、呕吐或鼻胃管引流出胆汁性液体作为POGD的诊断标准,将患儿分为POGD组和非POGD组,收集两组患儿基线资料、术中情况、术后恢复情况、二期肠造瘘闭合手术情况进行单因素分析,将P＜0.05的自变量纳入二元Logistic回归,分析婴儿肠造瘘手术后胃肠功能恢复的影响因素。结果 共216例患儿在婴儿期接受肠造瘘手术,其中早产儿98例(45.37%)。原发疾病中,新生儿坏死性小肠结肠炎(necrotizing enterocolitis of newborn,NEC)54例(54/216,25.00%)、肛门直肠畸形51例(51/216,23.61%)、肠闭锁31例(31/216,14.35%);合并消化道穿孔69例(31.94%)。POGD组主要为NEC(47例)、肠闭锁(24例),非POGD组以肛门直肠畸形为主(44例)。POGD组较非POGD组手术时间长,术中输血量多,且多伴有肠管不良情况(如水肿、坏死或穿孔、粘连)。POGD组、非POGD组术后胃肠减压引流量［161.00（102.50,268.00）mL比35.00（7.00,80.00）mL］、肠外营养时间［22.00（14.00,40.00）d 比8.00（5.00,13.00） d）］、住院时间［28.00（19.00,52.00）d 比13.00（10.00,22.00）d］以及术后首次排便时间［2.00（1.00,3.00）d 比2.00（1.00,2.00）d］比较，差异均有统计学意义（P<0.05）。POGD组术后C-反应蛋白（C-reactive protein,CRP）升高更显著（P=0.004），且造瘘手术后出现POGD的患儿在二期肠造瘘闭合手术后发生POGD的可能性更大（36.09%比8.43%）。一期肠造瘘术后发生POGD组较未发生POGD组在二期肠造瘘闭合手术前的WAZ评分较低，手术时长、术后住院天数、肠外营养持续时间及禁食时间更长，围手术期输血量更多（P＜0.05）。多因素Logistic回归分析显示，术中肠坏死或穿孔（OR=3.671，95%CI：1.443~9.341）、原发病为NEC（OR=10.871，95%CI：2.269~52.076）、原发病为肠闭锁（OR=7.228，95%CI：1.633~32.001）是婴儿肠造瘘手术后发生POGD的独立危险因素（P＜0.05）。结论 肠坏死或穿孔、原发病为NEC或肠闭锁是婴儿肠造瘘手术后发生胃肠功能障碍的独立危险因素。肠造瘘手术后出现POGD的患儿二期肠造瘘闭合手术前WAZ评分较低,且手术后发生POGD的风险增高。
- 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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备注/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