Short-term surgical outcomes of preterm infants with necrotizing enterocolitis: A single-center experience.
Short-term surgical outcomes of preterm infants with necrotizing enterocolitis: A single-center experience.
复制标题
早产儿坏死性小肠结肠炎的短期手术结果单中心经验
DOI：
10.1097/md.0000000000004379
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发表时间：
2016-07
期刊：
影响因子：
1.6
通讯作者：
Xi Z
中科院分区：
文献类型：
--
作者：
Sheng Q;Lv Z;Xu W;Liu J;Wu Y;Shi J;Xi Z
本研究的目的是分析该院早产儿坏死性小肠结肠炎(NEC)的疾病性质、手术方式、并发症和存活率。回顾分析2010年1月至2014年12月34例早产儿(胎龄37周)外科NEC的病历资料。将患者分为低出生体重组(LBW，2500 g，n = 27)和正常出生体重组(NBW，≥2500 g，n = 7)。LBW组和NBW组在胎龄(31.2 ± 2.2周比36.3 ± 0.5周)和呼吸支持(55.5%比0%)方面有显著差异。NEC发病的中位年龄分别为出生后12天和5天。胎龄与NEC发病日期呈负相关(r = −0.470)。气腹、阳性穿刺术和进行性临床恶化是开腹手术的指征。两组患者的病情程度、肠道受累程度、手术操作和术后并发症发生率均无差异。手术方式的选择往往取决于疾病的严重程度(大多数局部性和多灶性婴儿行肠造口术，83.3%的全肠患者行单纯引流，P <； 0.001)。术后并发症发生率为70.5%。最常见的并发症是败血症、肠管狭窄和短肠综合征。低体重组的中位住院天数显著延长(65天比19天，P = 0.004)。总的术后180d生存率为70.6%(70.4%vs.71.5%，P = 0.890，LOG RANK检验)。疾病严重程度是死亡的主要危险因素(局限性8.3%，多发性18.7%，泛肠道100%，P <； 0.001)。外科NEC的短期结果是严重的。本研究的高死亡率和术后并发症迫切需要在早期识别、迅速手术和更好的围手术期护理方面进行改进。
The purpose of this study was to analyze the nature of the disease, the surgical procedures, complications, and survival of preterm infants with necrotizing enterocolitis (NEC) at our institution. Medical records of 34 preterm (gestational age <37 weeks) infants with surgical NEC were retrospectively analyzed from January 2010 to December 2014. Patients were divided into 2 groups: low birth weight (LBW, <2500 g, n = 27) and normal birth weight (NBW, ≥2500 g, n = 7). The LBW and NBW groups differed dramatically in gestational age (31.2 ± 2.2 vs. 36.3 ± 0.5 weeks), and respiratory support (55.5% vs. 0%). The median age of NEC onset was 12 and 5 postnatal days respectively. There was an inverse association between gestational age and day of NEC onset (r = −0.470). Pneumoperitoneum, positive paracentesis, and progressive clinical deterioration were the indications for laparotomy. There was no difference in the extent of disease, in the bowel involvement, in the surgical procedures, and in the postoperative complication rates between the 2 groups. The choice of procedure has often depended upon the extent of disease (enterostomy was performed in most localized and multifocal infants, simple drainage was used in 83.3% pan-intestinal patients, P < 0.001). Postoperative complications occurred in 70.5% patients. The most common complications were sepsis, intestinal stricture, and short bowel syndrome. The median hospital stay was significantly longer in the LBW group (65 vs. 19 days, P = 0.004). The overall postoperative 180-day survival rate was 70.6% (70.4% vs. 71.5%, P = 0.890, log rank test). The severity of illness was the main risk factor for mortality (8.3% in localized, 18.7% in multifocal, and 100% in pan-intestinal, P < 0.001). The short-term outcomes for surgical NEC are grave. The high mortality and postoperative complications in this study mandate urgent improvements in early recognition, expeditious operation, and better perioperative care.