摘要
目的探讨新生儿肠闭锁(intestinal atresia,IA)合并胎粪性腹膜炎(meconium peritonitis,MP)患儿并发短肠综合征(short bowel syndrome,SBS)的临床特征。方法回顾性分析2019年1月至2023年5月湖南省儿童医院收治的33例诊断为肠闭锁合并胎粪性腹膜炎患儿的临床资料。将其中肠切除术后42 d不能脱离静脉营养者纳入短肠综合征组(SBS组),共14例,男7例、女7例,年龄2~30 d;术后42 d内完全恢复肠内营养者纳入非短肠综合征组(non-short bowel syndrome,non-SBS组),共19例,男12例、女7例,年龄4~33 d。对比分析两组患儿产前超声检查结果、性别、胎龄、出生体重、临床表现、手术资料、初次喂养时间、初次排便时间(经瘘口或肛门)、肠外营养时间、住院时间以及存活率。结果本研究中SBS发生率为42.4%(14/33)。两组性别、胎龄、出生体重、入院年龄差异均无统计学意义(P>0.05);SBS组和Non-SBS组产前超声异常发生率分别为85.7%(12/14)和42.1%(8/19),行高位肠造瘘术人数占比分别为78.6%(11/14)和31.6%(4/19),肠外营养时间分别为79(64,120)d和17(12,21)d,住院时间分别为87(48,125)d和24(17,30)d,差异均具有统计学意义(P<0.05)。SBS组和Non-SBS组腹胀、呕吐、术前肠管扩张情况、手术后初次排便时间差异均无统计学意义(P>0.05),存活率分别为85.7%(12/14)和94.7%(18/19),差异无统计学意义(P>0.05)。结论新生儿肠闭锁合并胎粪性腹膜炎患儿的胎儿期超声异常提示手术后出现SBS的机率更高,此类SBS经过规范治疗可以获得痊愈。
Objective To explore the clinical characteristics of intestinal atresia(IA)complicated by meconium peritonitis(MP)in neonatorum with short bowel syndrome(SBS).Methods From January 2019 to May 2023,the relevant clinical data were retrospectively reviewed for 33 IA children with MP.A total of 14 patients failing to disintegrate from intravenous nutrition at Day 4 post-operation were included in short bowel syndrome(SBS)group.There were 7 boys and 7 girls with an age range of(2-30)day.Another 19 children with a complete bowel recovery within 42d were included in non-short bowel syndrome(Non-SBS)group.There were 12 boys and 7 girls with an age range of(4-33)day.Prenatal ultrasonography,gender,gestational age,birth weight,clinical manifestations,surgical findings,initial feeding time,initial defecation time(through fistula or anus),parenteral nutrition time,hospitalization stay and survival rate were compared between two groups.Results The incidence of SBS was 42.4%(14/33).No significant inter-group differences existed in gender,gestational age,birth weight or age at admission(P>0.05).Abnormal rate of prenatal ultrasonography in SBS and non-SBS groups were 85.7%(12/14)and 42.1%(8/19),respectively.Proportion of children undergoing high enterostomy was 78.6%(11/14)and 31.6%(4/19),duration of parenteral nutrition 79(64,120)and 17(12,21)day and duration of hospitalization 87(48,125)and 24(17,30)day with statistical significance(P<0.05).No significant inter-group differences existed in abdominal distension,vomiting,preoperative intestinal dilation or initial defecation time(P>0.05).Survival rate of SBS and non-SBS groups was 85.7%(12/14)and 94.7%(18/19)with no statistical significance(P>0.05).Conclusions Abnormal fetal ultrasonography of neonatal intestinal atresia complicated with MP hints at a higher postoperative probability of SBS.This type of SBS may be cured conventionally.
作者
邹婵娟
李波
董洁
李明
冯勇
夏仁鹏
周崇高
Zou Chanjuan;Li Bo;Dong Jie;Li Ming;Feng Yong;Xia Renpeng;Zhou Chonggao(Department of Fetal&Neonatal Surgery,The Affiliated Children’s Hospital of Xiangya School of Medicine,Central South University(Hunan Children’s Hospital),Changsha 410007,China;Institute of Pediatric Medicine,The Affiliated Children’s Hospital of Xiangya School of Medicine,Central South University(Hunan Children’s Hospital),Changsha 410007,China)
出处
《临床小儿外科杂志》
CSCD
北大核心
2024年第12期1144-1148,共5页
Journal of Clinical Pediatric Surgery
基金
湖南省出生缺陷协同防治科技重大专项(2019SK1015)。
关键词
胎粪性腹膜炎
肠闭锁
短肠综合征
外科手术
儿童
Meconium Peritonitis
Intestinal Atresia
Short Bowel Syndrome
Surgical Procedures
Operative
Child
