新生儿胃穿孔特点及预后相关研究
Characteristics and prognoses of neonatal gastric perforation
王凯 1陈永卫 2蔡思雨 3何乐健 4郭卫红 2侯大为 2彭春辉 1庞文博 1陈亚军1
作者信息
- 1. 100045 国家儿童医学中心,首都医科大学附属北京儿童医院普外科
- 2. 100045 国家儿童医学中心,首都医科大学附属北京儿童医院新生儿外科
- 3. 100045 国家儿童医学中心,首都医科大学附属北京儿童医院临床流行病与循征医学中心
- 4. 100045 国家儿童医学中心,首都医科大学附属北京儿童医院病理科
- 折叠
摘要
目的 探讨新生儿胃穿孔的临床特点及预后相关因素.方法 回顾性分析2005年1月1日至2017年6月30日就诊于首都医科大学附属北京儿童医院外科,年龄≤28 d,明确诊断为胃穿孔的患儿27例,男21例(77.78％),女6例(22.22％),平均年龄4.05 d(3.24～7.01 d).12例(44.44％)患儿病因为胃壁肌层缺损,1例(3.71％)患儿为应激性胃溃疡穿孔;14例(51.85％)无明确病因.16例患儿(59.26％)穿孔位于胃壁大弯侧,3例(11.11％)位于胃壁小弯侧,6例(22.22％)位于胃前壁,2例(7.41％)位于胃后壁.分析其临床特点;根据患儿是否存活,将其分为病死组与存活组,对比两组患儿胃穿孔相关指标间的差异,以探讨影响预后的相关因素;对存活组患儿进行随访,了解其生存情况.结果 符合纳入标准的27例患儿中,病死组10例(37.04％),存活组17例(62.96％),两组间年龄、性别、是否早产、是否低出生体重、是否存在围生期不良事件、是否伴发消化道畸形、症状到手术时间、穿孔长度、是否存在胃壁肌层缺损均无统计学差异(P＞0.05);而是否存在胃肠道缺血坏死(P=0.002)和病程中是否出现多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)在两组中差异有统计学意义(P＜0.001).对存活组17例患儿随访(39.40±26.33)个月,患儿一般情况及生长发育良好,其中2例(11.76％)因术后粘连性肠梗阻再次手术治疗.结论 新生儿胃穿孔病死率高达37.04％,患儿围生期情况及有无消化道畸形对预后影响不大,而疾病的严重程度决定患儿预后,早期的诊断、积极手术干预对改善预后至关重要.
Abstract
Objective To explore the characteristics of neonatal gastric perforation and analyze its prognostic factors.Methods From January 2005 to June 2017,27 neonatal patients diagnosed as gastric perforation were recruited and their characteristics were analyzed.There were 21 boys (77.78％) and 6 girls (22.22％) with a mean age of 4.05 (3.24-7.01) days.The causes were congenital gastric muscular wall defects (n =12,44.44％),gastric stress ulcer perforation (n =1,3.71％) and non-specific (n =14,51.85％).And the locations were at great curvature (n =16,59.26 ％),lesser curvature (n =3,11.11％),anterior wall (n =6,22.22％) and posterior wall (n =2,7.41％).Prognostically they were divided into fatality and survival groups.Relevant factors of two groups were analyzed and follow-ups conducted for survival group.Results Among them,17 (62.96％) were in survival group and 10 (37.04％) in fatality group.Age,gender,prematurity,low birth weight,perinatal adverse events,alimentary malformation,time from onset to surgery,length of perforation and congenital gastric muscular wall defects had no statistically significant inter-group differences (P ＞ 0.05).And gastrointestinal ischemia & necrosis and multiple organ dysfunction syndrome (MODS) were statistically significant (P＜0.001).During a follow-up period of 39.40 ± 26.33 months,17 survivors had favorable growth and development.Only 2 cases (11.76％) of intestinal obstruction required a second surgery.Conclusions Neonatal gastric perforation has a fatality rate of 37.04％.Severity of disease determines its prognosis instead of perinatal condition or alimentary malformation.Early diagnosis and timely surgery favorably affects its prognosis.
关键词
胃穿孔/预后/病死率Key words
Gastric perforation/Prognosis/Fatality rate引用本文复制引用
出版年
2018
NETL
NSTL
维普
万方数据