临床小儿外科杂志2024，Vol.23Issue(2)：135-139,5.DOI:10.3760/cma.j.cn101785-202203001-007
新生儿坏死性小肠结肠炎保守治疗后肠狭窄的临床特点及诊治探讨
Clinical features and outcomes of intestinal strictures after conservative measures for necrotizing en-terocolitis
摘要
Abstract
Objective To summarize the clinical features of intestinal stricture after conservative meas-ures for neonatal necrotizing enterocolitis(NEC)and compare the outcomes of single and multiple stricture groups.Methods From January 2014 to December 2020,retrospective review was performed for the relevant clinical data of 67 neonates operated for post-NEC intestinal strictures.Basic information,NEC onset time,Bell stage,radiographic studies,surgical approach postoperative complications were recorded.Then they were as-signed into two groups of single stricture and multiple strictures and the prognosis between two groups were com-pared.Results Positive rate of preoperative contrast enema was 83.9％.Primary end-to-end anastomosis(n=60)and enterostomy(n=7)were performed at a median of 39 days after NEC with a median weight of 2.53 kg.Multiple strictures were detected in 33 neonates(49.3％)while the remainders had only 1 stricture.There were a total of 123 strictures.Except for 1 stricture spanning small intestine and colon(from terminal ileum to sigmoid colon),65 strictures were present in small intestine,including terminal ileum(n=37)and colon(n=57)(ascending colon,n=27).Two cases underwent enterostomy later due to disease deterioration and 1 died at Month 2 after discharge.Another child accepted enterostomal closure 12 months later.Complications included intestinal prolapse(n=2)and adhesive intestinal obstruction(n=4).The long-term survival rate of intestinal strictures after conservative measures was 95.5％(64/67).Length of bowel resection(P＜0.001)and opera-tive duration(P=0.008)were significantly longer in multiple-stricture group than those in single-stricture group.However,no significant inter-group difference existed in time to complete enteral feeding(P=0.862)or postoperative complications(P=0.347).Conclusions Despite a low incidence of intestinal strictures after conservative measures for NEC,multiple strictures account for a large proportion.The strictures occur predomi-nantly in terminal ileum and colon.Contrast enema is valuable for preoperative examination.All intestinal seg-ments should be carefully explored intraoperatively.And multiple strictures have no effect upon postoperative re-covery and outcomes.关键词
坏死性小肠结肠炎/保守治疗/肠狭窄/婴儿,新生Key words
Necrotizing Enterocolitis/Conservative Treatment/Intestinal Stricture/Infant,Newborn引用本文复制引用
曹旭清,潘晓雪,沈淳..新生儿坏死性小肠结肠炎保守治疗后肠狭窄的临床特点及诊治探讨[J].临床小儿外科杂志,2024,23(2):135-139,5.基金项目
国家自然科学基金面上项目(81873849)National Natural Science Foundation of China(81873849) （81873849）
