母乳喂养预防极低出生体重儿坏死性小肠结肠炎作用分析

目的 探讨母乳喂养对极低出生体重儿的新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis,NEC)发生率的影响.方法 对2014年1月—2015年11月治疗的120例极低出生体重儿资料进行回顾性分析.根据喂养方式的不同分为观察组和对照组,每组60例.观察组采用人乳喂养,对照组采用配方奶喂养.比较并分析两组NEC发生率及NEC严重程度、喂养不耐受性、住院时间、肝内胆汁淤积症发生率及胃动素和胃泌素水平.结果观察组NEC发生率、BellⅢ期和喂养不耐受比例均明显低于对照组(P<0.05).两组出生第1、7和14天胃动素和胃泌素水平比较差异无统计学意义(P>0.05).结论 极低出生体重儿早期应用母乳喂养,可有效地降低喂养不耐受性、NEC发生率及其严重程度,且不会对胃动素和胃泌素造成影响.     

儿童粒细胞缺乏性小肠结肠炎的诊断和处理

目的 粒细胞缺乏性小肠结肠炎在临床上以粒细胞缺乏、腹痛和高热为三大主症.本文回顾了粒细胞缺乏性小肠结肠炎患儿17例,对其临床特征、治疗和预后进行分析.方法 总结复旦大学附属儿科医院2004至2009年5年间粒细胞缺乏性盲肠炎息儿的临床资料,并进行文献复习.结果 17例患儿,男11例,女6例,平均年龄7.2岁.2例淋巴瘤,11例白血病,1例再生障碍性贫血,1例神经母细胞瘤,2例单纯性粒细胞缺乏而无明显的基础性疾病证据.所有患儿均有典型的临床表现,4例有弥漫性腹膜炎,中毒性休克,其中3例需要呼吸机辅助通气治疗.体检发现有右下腹压痛和肌紧张.伴有CRP的升高和电解质的紊乱.血培养阳性率47%.CT、B超提示肠壁增厚,盲肠或右侧结肠充气减少,气腹等.13例患儿接受内科保守治疗,4例手术干预.2例死亡.结论 粒细胞缺乏性小肠结肠炎是由粒细胞缺乏所引起的危及生命的消化道并发症,临床及CT表现可明确诊断.早期发现和积极的内科治疗可减少病死率.大多数的患儿可通过保守治疗,避免外科手术而获得良好的预后.

Abstract：

Objective To summarize our experience with disgnosis and treatment of neutropenic enterocolitis in children. Methods From 2004 to 2009, 17 patients were diagnosed with neutropenic enterocolitis, and treated at this center. Their clinical data were retrospectively analyzed to summarize the clinical features, managment experience and evaluate the outcome of neutropenic enterocolitis. Results Among the 17 patients, 11 were males and 6 were females. Their avergae age at diagnosis was 7. 2 years old. The primary diseases that caused neutropenia in these patients were lyphoma in 2 patients, leukemia in 11 patients,aplastic anemia in 1, neuroblastoma in 1, and primary neutropenia in 2. All the patients presented enterocolitis symptoms like fever, vomitting, and diarrhea. Physical examination found lower right abdominal pain and abdominal rigidity. C-reactive protein (CRP) and electrolyte disorder were also noted in these patients. The postive culture rate of blood bacterial was 47%.Computered tomography and ultrasonography revealed intestinal wall thickening, decreased air content in cecum and right colon, and peumoperitoneum. Four patients had diffused peritonitis and sepsis shock. Three of them need mechical ventilation. Among the 17 patients, 4 had surgery. Two patients died. Conclusions Neutropenic enterocolitis is a life-threatening gastrointestinal complication of neutropenia. Early diagnosis and intervention can reduce mortality and improve the prognose of these patients.     

降钙素基因相关肽在新生儿坏死性小肠结肠炎发病机理中作用的实验研究

目的　探讨新生儿坏死性小肠结肠炎 (NEC)发病机理 ,为寻找其内源性保护物质提供实验室依据。　方法　以健康 7日龄 Wistar新生鼠分组并制备缺血再灌注 (I/ R)及缺血预处理 (IPC)实验模型 ,分别测定血浆降钙素基因相关肽 (CGRP)浓度、乳酸脱氢酸 (L DH )活性、小肠组织丙二醛(MDA)含量及湿重 /干重 (WW/ DW)比值 ,并制备病理切片光镜下观察形态学变化。　结果　实验各组血浆 CGRP浓度除 IPC组与 IPC+I/ R组差异无显著性外 [(2 92± 17与 2 82± 19) pg/ L(q=1.82 ,P>0 .0 5 ) ],其余各组间差异均有显著性 [(12 4± 10与 16 2± 2 4 ) pg/ L(q=7.16 ) ;(12 4± 10与 2 92± 17)pg/ L(q=4 2 .0 1) ;(16 2± 2 4与 2 92± 17) pg/ L(q=2 1.73,P值均 <0 .0 1) ],IPC组 CGRP较对照组及I/ R组均明显升高。血浆 L DH在 I/ R时较对照组明显升高 [(190± 2 4与 4 6± 9) U / L (q=2 6 .70 ,P<0 .0 1) ],而在 IPC组及 IPC+I/ R组较 I/ R组又有明显下降 [(12 2± 15与 190± 2 4 ) U / L (q=11.77) ;(138± 15与 190± 2 4 ) U/ L(q=6 .39;P值均 <0 .0 1) ]。 I/ R时小肠 MDA含量较对照组明显增加[(1.5 1± 0 .10与 0 .6 1± 0 .0 7) nm ol/ mg(q=36 .12 ,P<0 .0 1) ],而在 IPC及 IPC+I/ R时较 I/ R组则又明显下降     

小肠结肠炎耶尔森氏菌肠炎10例临床分析

10例经细菌学证实的小肠结肠炎耶尔森氏茵肠炎,8例胃肠炎型,2例败血症型。临床表现以发热、腹泻、呕吐、腹痛、全身中毒症状为主。病程5～15天。复方新诺明、卡那霉素等抗菌治疗,配合对症和支持疗法,9例治愈,1例死于输液反应。     

Primary versus secondary anastomosis in intestinal atresia

Purpose

Neonates with intestinal atresia (IA) undergo either primary anastomosis (PA) or ostomy creation with secondary anastomosis (SA). Our purpose was to compare outcomes for PA and SA and to assess factors influencing procedure selection.

Intestinal mucosa remodeling by recombinant human epidermal growth factor(1-48) in neonates with severe necrotizing enterocolitis

Background and Aims

Neonatal necrotizing enterocolitis (NEC) is a common and serious acquired gastrointestinal tract condition. This clinical study assessed the potential clinical efficacy and microscopic effects of recombinant human epidermal growth factor 1-48 (EGF_1-48) in neonates with NEC.

Methods

This prospective, double-blind, randomized controlled study included 8 neonates with NEC. The study compared the effects of a 6-day continuous intravenous infusion of EGF_1-48 at 100 ng kg⁻¹ h⁻¹ against placebo. Clinical outcomes and morphological evaluation of serial rectal mucosal biopsies were assessed at baseline and 4, 7, and 14 days after starting EGF infusions.

Results

There was no difference between the clinical safety outcomes recorded for EGF_1-48 or placebo patients. Quantitative morphologic differences in the rectal mucosa biopsies were noted with EGF_1-48 treatment compared with baseline or placebo and included a statistically significant increase in the number of mitoses per mucosal crypt on study day 4, significantly increased thickness of rectal mucosa from baseline on study days 4 and 7, and increased crypt surface area of rectal mucosa in parallel with increased mucosa thickness on day 14.

Conclusion

This study of EGF_1-48 in neonates with severe NEC showed that growth factor treatment was well tolerated and produced positive and measurable remodeling trophic effects on the gastrointestinal mucosa.     

Elk-1通路对肠三叶因子治疗坏死性小肠结肠炎的影响

目的探讨Elk-1通路对肠三叶因子（ITF）治疗坏死性小肠结肠炎（NEC）的影响。方法30只新生Wistar大鼠随机分为3组（正常组对照组,NEC模型组,NEC给予ITF组）,每组10只,造NEC模型后,第4d处死并取回盲部组织1-2cm固定、包埋、切片、HE染色,观察组织学变化及免疫组化Elk-1的表达。结果NEC新生大鼠中损伤肠组织Elk-1表达增强,ITF治疗组肠组织Elk-1表达较NEC组明显增强。结论Elk-1信号通路可能参与了NEC发病过程,并起着信号转导作用;ITF通过激活Elk-1信号通路,减轻肠组织损伤,起到保护肠黏膜的作用。     

Endorectal pull-through for Hirschsprung's disease—a multicenter, long-term comparison of results: transanal vs transabdominal approach

Purpose

Previous studies have reported decreased continence in patients undergoing transanal endorectal pull-through (TERP) for Hirschsprung's disease compared to the older transabdominal approach (TAA). To address this, we examined long-term stooling outcomes in a large, multicenter cohort of patients undergoing either TERP or TAA.

Methods

Data were collected from 5 large pediatric institutions. Patient families were surveyed using a stooling score system (0-40, best to worst total score). Inclusion criteria included patients older than 3 years and those who had more than 6 months of recovery after pull-through. Those with total colonic aganglionosis were excluded. Statistical analysis included univariate and multivariate linear regression (significance, P < .05).

Results

Two hundred eighty-one patients underwent TERP (192) or TAA (89). Interviews were completed in 149 (104 [52%] TERP vs 45 [52%] TAA). The TAA group had a significantly greater number of daily bowel movements for each respective postoperative year and experienced more early complications (3% vs 1% with >1 complication; P = .061) and late complications (19% vs 4% with >1 complication; P < .001). Although the TAA group had a higher mean enterocolitis score (3.3 ± 0.4 vs 1.8 ± 0.2; P < .001), this was not borne out by multivariate regression analysis (P = .276). Parental survey showed that there were no significant differences between procedures in mean total, continence, or stooling pattern scores.

Conclusion

Transanal endorectal pull-through was associated with fewer complications and fewer episodes of enterocolitis. In contrast to prior studies, TERP patients did not have a higher rate of incontinence. These results support use of TERP as an excellent surgical approach for children with Hirschsprung's disease.     

Patterns of postoperative enterocolitis in children with Hirschsprung's disease combined with hypoganglionosis

Objective

The relationship between postoperative enterocolitis (EC) and Hirschsprung's disease (HD) combined with hypoganglionosis (HYP) has not been thoroughly reported elsewhere. The aim of this study was to investigate the incidence of EC after operation in children with HD combined with HYP and to identify new strategies to prevent postoperative EC.

Methods

From 1998 to 2005, 97 children with HD underwent the modified Swenson's procedure in this institute. They were classified into 2 groups based on pathologic investigation as follows: group A contained 70 patients with HD and group B contained 27 patients with HD complicated with HYP. The mean follow-up time from the time of the operation was 3.4 years (range, 1.5-8 years). The incidence of postoperative EC and anorectal functions were evaluated and compared between these 2 groups.

Results

Eight cases (11.4%) in group A developed postoperative EC, whereas 11 (40.7%) in group B did so. The incidence of postoperative EC in group A was significantly lower than that in group B (P < .005). According to the Rintala scoring system, the percentage of patients with an excellent score in group A (85.7%) was significantly higher than that in group B (P < .05). The recurrence rate of constipation in group B was 14.8% (4/27), whereas it was 2.8% (2/70) in group A.

Conclusions

Postoperative EC is associated with retained proximal HYP, which suggests that HYP could be, at minimum, a predictive marker for this complication. Complete resection of HYP segment could potentially minimize the incidence of postoperative EC and alleviate the severity of EC.