摘要
目的探讨新生儿坏死性小肠结肠炎（NEC）后肠狭窄临床特点和诊治经验。方法对我院白2005年1月至2010年12月收治的14例NEC后肠狭窄临床资料进行回顾性分析。14例Bell分期Ⅰ期2例，Ⅱ期9例，Ⅲ期3例。临床表现为喂养不耐受、胃潴留、呕吐、腹胀等，出现症状的平均时间为发生NEC后29．7d。11例腹部正侧位片均提示有固定扩张的肠袢；9例消化道造影，仅3例提示肠狭窄。术中发现狭窄部位：末端回肠8处、降结肠4处、结肠肝曲2处、结肠脾曲2处、升结肠1处、空肠中下段1处；其中4例为多发肠狭窄。14例中除1例放弃治疗均接受手术，8例Ⅰ期肠狭窄切除肠吻合术，其余分期手术。结果术后均治愈出院。9例获随访，除1例因并发粘连性肠梗阻再次手术治疗外均获满意效果。结论临床上NEC后反复喂养不耐受、腹胀应警惕肠狭窄发生。狭窄常发于结肠和末端回肠，必要时予以剖腹探查所有肠段，避免多发肠狭窄，多数Ⅰ期狭窄段切除肠吻合术效果良好。
Objective To study the clinical features and treatment experience of neonates with intestinal strictures after necrotizing enterocolitis. Methods Clinical data of 14 cases was studied ret- rospectively from January 2005 to December 2010. Results Among them, there were 2 patients with NEC Bell stage 1,9 patients with Bell stage 2,3 patients with Bell stage 3. The main symptoms of in- testinal obstruction were intolerance of feeding, gastric retention,vomitting and abdominal distension. A mean time of 29.7 days was found between the recovery from NEC and the diagnosis of late stric- tures. In 11 patients, X-ray showed a fixed and expanded ansa interstinalis. 9 patients underwent gas- trointestinal contrast study, with 3 showing intestinal strictures. Most intestinal strictures were found in the colon, and 4 patients had multiple strictures. All but one patients receivedoperative management, with reseetionof strictures and primary end-to-end anastomosis. One case developed post-operative ad- hesions and had to undergo second laparotomy. No recurrent stricturewasseen. Conclusions Strictures can develop easily in patients after NEC. A high index of suspicion must be kept in mind for these babies.
出处
《中华小儿外科杂志》
CSCD
北大核心
2012年第5期344-347,共4页
Chinese Journal of Pediatric Surgery
基金
上海市常见出生缺陷的综合防治（上海市卫生局重点项目,编号：2008ZD001）
关键词
新生儿
小肠结肠炎
坏死性
肠狭窄
Neonate
Enterocolitis,necrotizing
Intestinal stricture
