坏死性结肠炎致消化道穿孔新生儿的临床特点及预后
Clinical characteristics of necrotizing colitis-caused gastrointestinal perforation due to different etiologies and its prognosis
阳一平 1王榜珍 2蔡姣 3陈晓霞 2赵珣 2陈茂琼2
作者信息
- 1. 贵州医科大学附属医院新生儿科,贵州贵阳 550004;东莞市松山湖中心医院儿科,广东东莞 523000
- 2. 贵州医科大学附属医院新生儿科,贵州贵阳 550004
- 3. 贵州医科大学儿科学院,贵州贵阳 550004
- 折叠
摘要
目的 探讨坏死性结肠炎致消化道穿孔新生儿的临床表现及预后.方法 45例经剖腹探查明确穿孔部位的消化道穿孔新生儿,据穿孔病因分新生儿坏死性小肠结肠炎(NEC)组(n=21)和非NEC(Non-NEC)组(n=24),收集2组患儿性别、胎龄(GA)、出生体质量(BW)、开奶日龄、奶品、出现消化道症状日龄、手术日龄、是否胎膜早破及时间、穿孔部位及穿孔病因等一般资料,随访至6月龄,记录2组患儿预后情况(治愈、死亡及预后不良).结果 45例消化道穿孔新生儿中NEC 21例(46.67％),先天性消化道发育不良18例(40.0％),阑尾炎4例(8.89％)及特发性胃穿孔2例(4.44％);与Non-NEC组比较,NEC组患儿男性比率低、GA小、BW低、消化道症状出现晚、手术日龄晚、母乳喂养率低及胎膜早破发生率高,差异均有统计学意义(P＜0.05);NEC组患儿小肠及结肠复合穿孔19例(19/21,90.5％),Non-NEC组小肠穿孔17例(17/24,70.83％);45例患儿术后治愈出院32例(71.11％),死亡13例(28.89％),其中因术后多器官功能衰竭死亡10例;NEC组患儿死亡率(69.2％)高于Non-NEC组患儿(30.8％),差异有统计学意义(P＜0.05).结论 新生儿消化道穿孔病因以NEC最多见,其次是消化道发育不良,手术治疗预后良好.
Abstract
Objective To investigate the clinical manifestations of neonates with gastrointestinal perforation caused by necrotizing Colitis due to different etiologies and prognosis.Methods Forty-five neonates with gastrointestinal perforation who underwent laparotomy for a definite perforation site were divided into two groups based on etiology:neonatal necrotizing enterocolitis(NEC)group(n=21)and non-NEC(Non-NEC)group(n=24).General clinical data were collected from both groups,including gender,gestational age(GA),birth weight(BW),age of initiation of milk feeding,type of milk,age of onset of gastrointestinal symptoms,day age at surgery,whether premature rupture of membranes(PROM)occurred,the time,site of perforation and cause of perforation.Follow-up was conducted until six months of age,and the prognosis(cured,died or poor outcome)of two groups was recorded.Results Among the 45 neonates with gastrointestinal perforation,there were 21 cases with NEC(46.67％),18 cases with congenital gastrointestinal developmental dysplasia(40.0％),4 cases with appendicitis(8.89％)and 2 cases with idiopathic gastric perforation(4.44％).When compared to Non-NEC group,NEC group had low male ratio,small GA,low BW,late onset of gastrointestinal symptoms,late day age at surgery,low breast feeding rate and high incidence of PROM(P＜0.05).In NEC group,19 cases(19/21,90.5％)had combined small intestine and colon perforations.In Non-NEC group,17 cases(17/24,70.83％)had small intestine perforation.Of the 45 pediatric patients,32 cases(71.11％)were cured and discharged after surgery,and 13(28.89％)died,including 10 deaths due to postoperative multiple organ failure(MOF).The mortality rate of NEC group(69.2％)was higher than that of Non NEC group(69.2％vs 30.8％,P＜0.05).Conclusion NEC is the most common cause of gastrointestinal perforation in newborns,followed by gastrointestinal dysplasia.The clinical manifestations and locations of gastrointestinal perforation vary depending on the causes.Surgery has a good prognosis.
关键词
小肠结肠炎,坏死性/阑尾炎/新生儿/消化道穿孔/新生儿坏死性小肠结肠炎/消化道发育不良/病因Key words
enterocolitis,necrotizing/appendicitis/neonatal/digestive tract perforation/neonatal necrotizing enterocolitis/digestive tract dysplasia/etiology引用本文复制引用
基金项目
贵州省卫生健康委科学技术基金项目(gzwjkj2020-1-143)
出版年
2024
NETL
NSTL
万方数据