79例新生儿坏死性小肠结肠炎后肠狭窄临床特点及诊疗体会

刘国斌; 郭振华; 王佚; 刘伟; 李晓庆

doi:10.16016/j.1000-5404.201810196

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79例新生儿坏死性小肠结肠炎后肠狭窄临床特点及诊疗体会

临床医学 | 更新时间：2026-03-02

- 79例新生儿坏死性小肠结肠炎后肠狭窄临床特点及诊疗体会
- Clinical features and management of intestinal strictures after neonatal necrotizing enterocolitis: analysis of 79 cases
- 第三军医大学学报 2019年41卷第8期页码：799-804
- 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：
  
  重庆市卫计委医学科研重点资助项目(20141010)
- DOI：10.16016/j.1000-5404.201810196
  中图分类号： R181.32;R726.567;R726.569
- 收稿：2018-10-30，
  
  纸质出版：2019-04-30
- 稿件说明：
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刘国斌, 郭振华, 王佚, 等. 79例新生儿坏死性小肠结肠炎后肠狭窄临床特点及诊疗体会[J]. 第三军医大学学报, 2019,41(8):799-804.

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.
刘国斌, 郭振华, 王佚, 等. 79例新生儿坏死性小肠结肠炎后肠狭窄临床特点及诊疗体会[J]. 第三军医大学学报, 2019,41(8):799-804. DOI： 10.16016/j.1000-5404.201810196.

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

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