Meconium-related ileus in extremely low-birthweight neonates: Etiological considerations from histology and radiology
Meconium-related ileus in extremely low-birthweight neonates: Etiological considerations from histology and radiology
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DOI：
10.1111/j.1442-200x.2011.03381.x
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发表时间：
2011-12-01
影响因子：
1.4
通讯作者：
Nakayama, Masahiro
中科院分区：
文献类型：
--
作者：
Kubota, Akio;Shiraishi, Jun;Nakayama, Masahiro
背景：日本儿科外科学会进行的一项全国新生儿外科调查表明，在过去的15年中，新生儿肠道穿孔的死亡率有所上升。随着极低出生体重（ELBW）新生儿存活率的增加和ELBW活产率的增加，极低出生体重（ELBW）新生儿肠道穿孔的发生率一直在增加。与坏死性小肠结肠炎（NEC）和局灶性肠穿孔（FIP）不同，粪相关肠梗阻的发病机制尚不清楚，其定义为以粪排泄延迟和微结肠为特征的功能性肠梗阻。方法：回顾13例ELBW新生儿肠穿孔继发于粪相关肠梗阻的组织学资料，回顾33例经对比灌肠诊断为粪相关肠梗阻的影像学资料。从16名无胃肠道疾病的ELBW新生儿中获得的标本作为年龄匹配的组织学评估对照。结果：粪粪相关性肠梗阻组与对照组神经节细胞核大小分别为47.3 +/- 22.0 mm(2)和37.8 +/- 11.6 mm(2)，差异无统计学意义。在所有粪相关肠梗阻病例中，对比灌肠均显示微结肠或小结肠，回肠口径逐渐改变，并因回肠或结肠内的粪而充盈缺损，显示口径改变和充盈缺损的位置不同。结论：神经节形态不成熟不是粪性肠梗阻的发病机制。密集的胎便嵌塞不是梗阻的原因，而是出生前肠蠕动不足过度吸水的结果，尽管胎儿蠕动不足的潜在机制尚不清楚。
Background: A nationwide survey on neonatal surgery conducted by the Japanese Society of Pediatric Surgeons has demonstrated that the mortality of neonatal intestinal perforation has risen over the past 15 years. The incidence of intestinal perforation in extremely low-birthweight (ELBW) neonates has been increasing as more ELBW neonates survive and as the live-birth rate of ELBW has increased. In contrast to necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP), the pathogenesis of meconium-related ileus, defined as functional bowel obstruction characterized by delayed meconium excretion and microcolon, remains unclarified.Methods: The histology of 13 ELBW neonates with intestinal perforation secondary to meconium-related ileus was reviewed, and the radiology of 33 cases of meconium-related ileus diagnosed on contrast enema was reviewed. Specimens obtained from 16 ELBW neonates without gastrointestinal disease served as age-matched controls for histological assessment.Results: The size of the ganglion cell nucleus in meconium-related ileus and in control subjects was 47.3 +/- 22.0 mm(2) and 37.8 +/- 11.6 mm(2), respectively, which was not significantly different. In all cases of meconium-related ileus, contrast enema demonstrated a microcolon or small-sized colon, with a gradual caliber change in the ileum and filling defects due to meconium in the ileum or colon, showing not-identical locations of caliber changes and filling defects.Conclusion: Morphological immaturity of ganglia was not suggested to be the pathogenesis of meconium-related ileus. Impaction of inspissated meconium is not the cause of obstruction, but the result of excessive water absorption in the hypoperistaltic bowel before birth, although the underlying mechanism responsible for the fetal hypoperistalsis remains unclear.