Clinical features and management of intestinal strictures after neonatal necrotizing enterocolitis: analysis of 79 cases

Guobin LIU; Zhenhua GUO; Yi WANG; Wei LIU; Xiaoqing LI

doi:10.16016/j.1000-5404.201810196

您当前的位置：

首页 >

文章列表页 >

Clinical features and management of intestinal strictures after neonatal necrotizing enterocolitis: analysis of 79 cases

更新时间：2026-03-02

- Clinical features and management of intestinal strictures after neonatal necrotizing enterocolitis: analysis of 79 cases
- Journal of Third Military Medical University Vol. 41, Issue 8, Pages: 799-804(2019)
- 作者机构：
  
  400014 重庆，重庆医科大学附属儿童医院胃肠新生儿外科，儿童发育疾病研究教育部重点实验室，儿科学重庆市重点实验室，重庆市儿童发育重大疾病诊治与预防国际科技合作基地Department of Neonatal Gastrointestinal Surgery, Key Laboratory of Child Development and Disorders of Ministry of Education, Chongqing Key Laboratory of Pediatrics, Chongqing International Science and Technology Cooperation Base for Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- 作者简介：
- 基金信息：
  
  the Key Project of Medical Research of Chongqing Municipal Health and Family Planning Commission(20141010)
- DOI：10.16016/j.1000-5404.201810196
  CLC： R181.32;R726.567;R726.569
- Received：30 October 2018，
  
  Published：30 April 2019
- 稿件说明：
移动端阅览
Guobin LIU, Zhenhua GUO, Yi WANG, et al. Clinical features and management of intestinal strictures after neonatal necrotizing enterocolitis: analysis of 79 cases[J]. Journal of Third Military Medical University, 2019, 41(8): 799-804.
DOI：

Guobin LIU, Zhenhua GUO, Yi WANG, et al. Clinical features and management of intestinal strictures after neonatal necrotizing enterocolitis: analysis of 79 cases[J]. Journal of Third Military Medical University, 2019, 41(8): 799-804. DOI： 10.16016/j.1000-5404.201810196.

摘要

目的

探讨新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis，NEC)后肠狭窄的临床特点和诊疗体会，并总结经验。

方法

回顾性分析收集本院2014年4月至2018年6月收治的79例NEC后肠狭窄患儿临床资料，并回访其预后和生长发育情况。79例患儿中，Bell分期Ⅰ期20例，Ⅱ期52例，Ⅲ期7例。所有患儿术前行X线腹部立卧侧位片，73例行消化道造影术，69例行直肠黏膜活检术。患儿均接受手术治疗。

结果

NEC后肠狭窄出现症状体征的平均时间为46.5 d，术前行钡剂灌大肠造影提示58例肠狭窄，6例胎儿型结肠。69例术前行直肠黏膜活检，有3例提示为巨结肠。术中发现狭窄部位主要是升结肠、横结肠及降结肠，其中32例为多发肠狭窄。79例患儿中，71例行Ⅰ期肠狭窄切除肠吻合术，其余分期手术。术后均治愈出院。73例获完整随访，3例术后出现粘连性肠梗阻表现，2例保守治疗，1例再次手术行肠粘连松解术后好转出院。8例因反复腹泻，导致营养不良及脱水，再次入院1~3次，最终痊愈出院。其余患儿均恢复较好，未见复发性肠狭窄。

结论

NEC后肠狭窄大多发生于结肠，且有多发狭窄可能。钡剂灌结肠造影是首选检查方法；治疗主要采用Ⅰ期肠狭窄切除肠吻合术，预后好。

Abstract

Objective

To summarize the clinical features and management of intestinal stricture following neonatal necrotizing enterocolitis (NEC).

Methods

We retrospectively analyzed the clinical data of 79 infants with intestinal stricture following NEC treated in our hospital between April

2014 and June

2018. Of the 79 infants

20 were diagnosed to have Bell stage I NEC

52 were in Bell stage Ⅱ and 7 in Bell stage Ⅲ. All the infants underwent preoperative X-Ray examination

73 had gastrointestinal contrast study and 69 had rectal mucosal biopsy.

Results

In these infants

the clinical signs of intestinal stricture occurred at a mean of 46.5 d following NEC. Among the 73 infants receiving gastrointestinal contrast study

58 were found to have intestinal stenosis and 6 had fetal colon. Rectal mucosal biopsy in 69 infants revealed Hirschsprung disease in 3 cases. Intraoperative exploration showed that intestinal stenosis occurred mostly in the ascending colon

transverse colon and descending colon

and multiple stenosis was detected in 32 cases. Surgical resection of stricture and primary end-to-end anastomosis were performed in 71 cases

and the remaining 8 cases underwent staged surgeries. In the 73 cases with complete follow-up data

3 had postoperative adhesions

and 2 of them received conservative treatment and the other underwent a second operation. Eight infants were hospitalized for 1 to 3 times for malnutrition and dehydration due to repeated diarrhea

and eventually recovered and were discharged smoothly; all the other infants had uneventful recovery without stricture recurrence.

Conclusion

Intestinal stenosis following NEC occurs most frequently in the colon

and some cases may have multiple strictures. Gastrointestinal contrast study is the primary option for examination. Surgical resection of the stricture and primary end-to-end anastomosis can achieve good therapeutic effect with favorable prognoses in the patients.

关键词

Keywords

references

HEIDA F H, LOOS M H, STOLWIJK L, et al . Risk factors associated with postnecrotizing enterocolitis strictures in infants[J ] . J Pediatr Surg, 2016, 51(7): 1126-1130. DOI: 10.1016/j.jpedsurg.2015.09.015.

ZHANG H, CHEN J P, WANG Y, et al . Predictive factors and clinical practice profile for strictures post-necrotising enterocolitis[J ] . Medicine (Baltimore), 2017, 96(10): e6273. DOI: 10.1097/MD.0000000000006273.

潘登, 王献良, 邵雷朋.新生儿坏死性小肠结肠炎经回肠造瘘术后远端肠闭锁7例[J].临床小儿外科杂志, 2016, 15(5): 513-515. DOI: 10.3969/j.issn.1671-6353.2016.05.028.

PAN D, WANG X L, SHAO L P. Management of acquired intestinal atresia after ileostomy due to necrotizing enterocolitis: A retrospec-tive study of 7 cases[J]. J Clin Pediatr Surg, 2016, 15(5): 513-515. DOI: 10.3969/j.issn.1671-6353.2016.05.028.

LAMIREAU T, LLANAS B, CHATEIL J F, et al . Increasing frequency and diagnostic difficulties in intestinal stenosis after necrotizing enterocolitis[J ] . Arch Pediatr, 1996, 3(1): 9-15.

陈虎, 钭金法.新生儿坏死性小肠结肠炎后肠狭窄临床特点和治疗现状[J].临床外科杂志, 2017, 25(12): 949-951.

CHEN H, DOU J F. Clinical features and treatments of the neonatal intestinal stenosis after necrotizing enterocolitis[J]. J Clin Surg, 2017, 25(12): 949-951.

JONA J Z. Acquired ileal atresia and spontaneous reconstitution of intestinal continuity in a premature infant with necrotizing enterocolitis[J]. J Pediatr Surg, 2000, 35(3): 505-507.

HOUBEN C H, LO A W, TSUI S Y, et al . Under pressure: a contribution to the pathogenesis of acquired ileal atresia[J ] . BMJ Case Rep, 2013, 2013: bcr2013201505. DOI: 10.1136/bcr-2013-201505.

董晨彬, 郑珊, 沈淳.新生儿坏死性小肠结肠炎后肠狭窄14例诊疗体会[J].中华小儿外科杂志, 2012, 33(5): 344-347. DOI: 10.3760/cma.j.issn.0253-3006.2012.05.007.

DONG C B, ZHENG S, SHEN C. Management of intestinal strictures after necrotizing enterocolitis: retrospective study of 14 cases[J]. Chin J Pediatr Surg, 2012, 33(5): 344-347. DOI: 10.3760/cma.j.issn.0253-3006.2012.05.007.

SCHIMPL G, H LLWARTH M E, FOTTER R, et al . Late intestinal strictures following successful tre atment of necrotizing enterocolitis[J ] . Acta Paediatr Suppl, 1994, 396: 80-83.

刘明坤, 张炳, 方一凡, 等.新生儿坏死性小肠结肠炎后肠狭窄18例诊疗分析[J].福建医药杂志, 2017, 39(1): 35-37.

LIU M K, ZHANG B, FANG Y F, et al . Diagnosis and treatment of 18 cases of intestinal stenosis after neonatal necrotizing enterocolitis[J ] . Fujian Med J, 2017, 39(1): 35-37.

GOETTLER C E, STALLION A, GRISONI E R, et al . An unusual late complication of necrotizing enterocolitis[J ] . J Pediatr Surg, 2001, 36(12): 1853-1854. DOI: 10.1053/jpsu.2001.28868.

余克驰, 吴晓娟, 冯杰雄, 等.小儿继发性肠狭窄及闭锁诊疗分析[J].中华小儿外科杂志, 2015, 36(3): 211-214. DOI: 10.3760/cma.j.issn.0253-3006.2015.03.012.

YU K C, WU X J, FENG J X, et al . Experiences of managing children with acquired intestinal stenosis and atresia[J ] . Chin J Pediatr Surg, 2015, 36(3): 211-214. DOI: 10.3760/cma.j.issn.0253-3006.2015.03.012.

徐和平, 李晓明, 高雅君, 等.腹部平片对先天性肠闭锁诊断价值的研究[J].医学影像学杂志, 2004, 14(9): 781-782. DOI: 10.3969/j.issn.1006-9011.2004.09.033.

XU H P, LI X M, GAO Y J, et al . Diagnostic value of congenital atresia of the intestine on plain abdomen film[J ] . J Med Imaging, 2004, 14(9): 781-782. DOI: 10.3969/j.issn.1006-9011.2004.09.033.

梁琼鹤, 张新荣, 杨明, 等.钡灌肠在新生儿坏死性小肠结肠炎后遗肠狭窄中的诊断价值[J].实用放射学杂志, 2017, 33(3): 476-477. DOI: 10.3969/j.issn.1002-1671.2017.03.040.

LIANG Q H, ZHANG X R, YANG M, et al . The value of barium enema in the post-necrotizing enterocolitis strictures[J ] . J Pracl Radiol, 2017, 33(3): 476-477. DOI: 10.3969/j.issn.1002-1671.2017.03.040.

HOUBEN C H, CHAN K W, MOU J W, et al . Management of intestinal strictures post conservative treatment of necrotizing enterocolitis: the long term outcome[J ] . J Neonatal Surg, 2016, 5(3): 28. DOI: 10.21699/jns.v5i3.379.

中华医学会小儿外科分会新生儿外科学组.新生儿坏死性小肠结肠炎外科手术治疗专家共识[J].中华小儿外科杂志, 2016, 37(10): 724-728. DOI: 10.3760/cma.j.issn.0253-3006.2016.10.002.

Neonatal Surgery Group, Pediatric Surgery Branch, Chinese Medical Association. Expert consensus on surgical treatment of neonatal necrotizing enterocolitis[J]. Chin J Pediatr Surg, 2016, 37(10): 724-728. DOI: 10.3760/cma.j.issn.0253-3006.2016.10.002.

MARTINEZ-FERRO M, ROTHENBERG S, ST PETER S, et al . Laparoscopic treatment of postnecrotizing enterocolitis colonic strictures[J ] . J Laparoendosc Adv Surg Tech, 2010, 20(5): 477-480. DOI: 10.1089/lap.2009.0428.

O'NEIL M, TEITELBAUM D H, HARRIS M B. Total body sodium depletion and poor weight gain in children and young adults with an ileostomy: A case series[J]. Nutr Clin Pract, 2014, 29(3): 397-401. DOI: 10.1177/088453 3614528543.

GOBET R, SACHER P, SCHW BEL M. Surgical procedures in colonic strictures after necrotizing enterocolitis[J]. Acta Paediatr, 1994, 83(s396): 77-79. DOI: 10.1111/j.1651-2227.1994.tb13250.x.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Risk factors for hospitalization within 24 h postnatally and respiratory support in late preterm and term neonates

Activation of aryl hydrocarbon receptor by autoinducer-2 alleviates intestinal injury in a neonatal mouse model of necrotizing enterocolitis

Protective effect of sodium butyrate on brain injury in mice with necrotizing enterocolitis

Protective effect of hypoxia-inducible factor-1α on brain injury in mice with necrotizing enterocolitis

Effects of necrotizing enterocolitis on brain injury and its severity in neonatal mice

Related Author

TANG Shuqing

WANG Li

PENG Lu

LIU Hui

Qi LU

Lingjun HU

Yuan SHI

Qing AI

Related Institution

Department of Pediatrics，University-Town Hospital of Chongqing Medical University

Department of Pediatrics，the Second Affiliated Hospital of Chongqing Medical University

Department of Neonatology, Yibin Hospital Affiliated to Children's Hospital of Chongqing Medical University

Department of Neonatology, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Child Development and Disorders of Ministry of Education, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University

Department of Neonatology, Key Laboratory of Child Development and Disorders of Ministry of Education, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Children's Hospital of Chongqing Medical University

⁰