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131.
Management of intestinal strictures after necrotizing enterocolitis: retrospective study of 14 cases
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 对我院自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29.7 d.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. 相似文献
132.
C. Dupont J.-P. Chouraqui A. Linglart A. Bocquet D. Darmaun F. Feillet M.-L. Frelut J.-P. Girardet R. Hankard J.-C. Rozé U. Simeoni A. Briend 《Archives de pédiatrie》2018,25(3):236-243
Cow's milk is one of the most common foods responsible for allergic reactions in children. Cow's milk allergy (CMA) involves immunoglobulin E (IgE)- and non-IgE-mediated reactions, the latter being both variable and nonspecific. Guidelines thus emphasize the need for physicians to recognize the specific syndromes of CMA and to respect strict diagnostic modalities. Whatever the clinical pattern of CMA, the mainstay of treatment is the elimination from the diet of cow's milk proteins. The challenge is that both the disease and the elimination diet may result in insufficient height and weight gain and bone mineralization. If, during CMA, the mother is not able or willing to breastfeed, the child must be fed a formula adapted to CMA dietary management, during infancy and later, if the disease persists. This type of formula must be adequate in terms of allergic efficacy and nutritional safety. In older children, when CMA persists, the use of cow's milk baked or heated at a sufficient temperature, frequently tolerated by children with CMA, may help alleviate the stringency of the elimination diet. Guidance on the implementation of the elimination diet by qualified healthcare professionals is always necessary. This guidance should also include advice to ensure adequate bone growth, especially relating to calcium intake. Specific attention should be given to children presenting with several risk factors for weak bone mineral density, i.e., multiple food allergies, vitamin D deficiency, poor sun exposure, steroid use, or severe eczema. When CMA is outgrown, a prolonged elimination diet may negatively impact the quality of the diet over the long term. 相似文献
133.
Neutropenic enterocolitis is an acute, life-threatening inflammation of the small and large bowel, often seen in children with malignancies during periods of prolonged or severe neutropenia. During the period 1990-1995, 180 children were treated at the authors' center for acute lymphoblastic leukemia using a standard chemotherapy protocol. Among them, 11 children (6.1%) aged 4 to 12 years, were diagnosed clinically to have neutropenic enterocolitis. Eight had severe neutropenia (absolute neutrophil count < 108/L and 5 had prolonged neutropenia (> 7 days duration). The symptoms included diffuse abdominal pain (10 children), oral mucositis (7), hematochezia (7), diarrhea (6), hematemesis (5), and right lower quadrant tenderness (4). Three children had radiological evidence of free intraperitoneal gas and an additional 3 children were found on surgical exploration to have cecal perforation. Laparotomy was performed on 8 children (73%), 4 of whom survived. Among the 3 children managed conservatively, 1 died awaiting surgical exploration, while the other 2 did well. The overall survival was 55%. The authors recommend an approach to management that respects the heterogeneity of the disease. 相似文献
134.
135.
新生儿先天性巨结肠合并小肠结肠炎的临床治疗及高危因素 总被引:14,自引:0,他引:14
目的探讨新生儿先天性巨结肠合并小肠结肠炎(HAEC)的临床特点及治疗方案。方法回顾性分析146例新生儿先天性巨结肠及合并21例HAEC的临床资料。结果在合并HAEC的21例病例中,16例作粪培养均有致病菌生长;8例行肠造瘘术,其中7例治愈,1例死亡;保守治疗13例,4例治愈,9例死亡。手术和保守治疗两种方法的疗效经统计学处理,P<0.05,差异有统计学意义。结论HAEC是新生儿先天性巨结肠的严重并发症,也是该病的主要致死原因;HAEC的发生与细菌感染有关;一旦发生HAEC,手术治疗的治愈率高于保守疗法,及时的肠造瘘手术是挽救患儿生命的有效方法。 相似文献
136.
目的探究联合检测高迁移率族蛋白B1(HMGB1)、肠型脂肪酸结合蛋白(I-FABP)诊断新生儿坏死性小肠结肠炎(NEC)的价值。
方法选择2016年7月至2018年7月西北妇女儿童医院收治的NEC新生儿119例(NEC组)以及同期非NEC患儿30例(对照组)。运用酶联免疫吸附法(ELISA)检测患儿粪便样本中HMGB1蛋白以及血清中I-FABP蛋白的表达水平,ROC曲线分析单项检测与联合检测对NEC的诊断效能。
结果Bell Ⅲ期NEC患儿的HMGB1、I-FABP蛋白表达水平均显著高于Ⅰ、Ⅱ期患儿(P<0.05),随着病情加重,蛋白水平呈逐渐上升趋势。NEC组患儿HMGB1、I-FABP蛋白水平显著高于对照组,差异有统计学意义(P<0.05)。联合应用两项指标诊断NEC的敏感度为89.60%,特异度为86.50%,ROC曲线下面积为0.985(P<0.01),诊断效能明显高于单项检测(P<0.05)。
结论HMGB1、I-FABP联合检测诊断NEC患儿敏感度及特异度高,动态测定HMGB1、I-FABP指标水平,有助于疑似NEC新生儿的早期筛查、治疗以及病程进展的判断。 相似文献
137.
难辨梭状芽孢杆菌相关性腹泻研究进展 总被引:1,自引:0,他引:1
难辨梭状芽孢杆菌是一种革兰阳性肠道病原体。难辨梭状芽孢杆菌相关性腹泻(CDAD)及其引起的假膜性肠炎为消化道多发病。难辨梭状芽孢杆菌可产生毒素A和毒素B,侵入肠黏膜后引起细胞病变,导致一系列感染相关临床表现。免疫学机制在难辨梭状芽孢杆菌感染相关疾病的发病中起重要作用。本文就CDAD的发病机制、临床表现及其检测和治疗作一综述。 相似文献
138.
Toby Debra Yanowitz Kevin M. Sullivan Anthony J. Piazza Beverly Brozanski Isabella Zaniletti Jotishna Sharma Robert DiGeronimo Sujir Pritha Nayak Rajan Wadhawan Kristina M. Reber Karna Murthy 《Journal of pediatric surgery》2019,54(4):712-717
Purpose
Quantify short-term outcomes associated with initial surgery [laparotomy (LAP) vs. peritoneal drain (PD)] for necrotizing enterocolitis (NEC) in extremely-low-birth-weight (ELBW) infants.Methods
Using the Children's Hospitals Neonatal Database, we identified ELBW infants < 32?weeks' gestation with surgical NEC (sNEC). Unadjusted and multivariable regression analyses were used to estimate the associations between LAP (or PD) and death/short bowel syndrome (SBS) and length of stay (LOS).Results
LAP was the more common initial procedure for sNEC (n?=?359/528, 68%). Infants receiving LAP were older and heavier. Initial procedure was unrelated to death/SBS in both bivariate (LAP: 43% vs PD: 46%, p?=?0.573) and multivariable analyses (OR?=?0.89, 95% CI?=?0.57, 1.38, p?=?0.6). LAP was inversely related to mortality (29% vs. 41%, p?<?0.007) in bivariate analysis, but not significant in multivariable analysis accounting for markers of preoperative illness severity. However, the association between LAP and SBS (14% vs. 5%, p?=?0.012) remained significant in multivariable analyses (adjusted OR?=?2.25, p?=?0.039). LOS among survivors was unrelated to the first surgical procedure in multivariable analysis.Conclusion
ELBW infants who undergo LAP as the initial operative procedure for sNEC may be at higher risk for SBS without a clear in-hospital survival advantage or shorter hospitalization.Level of evidence
Level II. 相似文献139.
140.
《Seminars in perinatology》2021,45(6):151454
The recently recognized connection between the gut microbiota and pulmonary disease has been termed the gut-lung axis. However, broader connections link the gut and the lungs and these organ systems are tightly interrelated in both homeostasis and disease. This concept is often ignored in the compartmentalized treatment of pulmonary or gastrointestinal disease. In newborns, the most severe gastrointestinal complication of prematurity, necrotizing enterocolitis, and the most severe pulmonary complication, bronchopulmonary dysplasia, both produce significant systemic morbidity. In this review, we highlight the often neglected pathophysiology of the gut-lung axis contributes to increased risk of bronchopulmonary dysplasia in premature infants with necrotizing enterocolitis. 相似文献