新生儿坏死性小肠结肠炎造瘘术后关瘘时机的选择

目的 多数具有手术指征的新生儿坏死性小肠结肠炎（NEC）患儿需要行坏死肠管切除+肠造瘘术。而对于术后多长时间关闭造瘘口较为合适,目前尚无共识。因此,本研究的目的是明确NEC造瘘术后关瘘的理想时机。方法 本研究回顾性分析了深圳市儿童医院新生儿外科2010年8月至2019年1月之间因NEC行坏死肠管切除+肠造瘘术并在术后一段时间后行关瘘术的患儿资料。为便于分析,我们将早期关瘘（EC）定义为造瘘术后8周内（含8周）,而晚期关瘘（LC）定义为造瘘术后8周后。结果 在58例患儿中,男35例,女23例。手术指征为气腹40例、保守治疗无法控制的感染18例,其中27例为早期关瘘（EC）,31例为晚期关瘘（LC）。关瘘术后EC组有18例患儿需要呼吸机支持（66.67%）,而LC组为10例（32.26%）（P<0.05）;EC组比LC组需要更长时间肠外营养支持;而且EC组的住院时间远高于LC组;共有13例患儿因粘连性肠梗阻的并发症接受了再次手术（其中EC组7例,LC组6例）;4例EC组患儿术后出现切口愈合不良,2例EC患儿因败血症死亡,1例EC患儿因短肠综合征和严重的营养不良死亡,而LC组患儿术后切口均恢复良好,无一例死亡。结论 本研究提示,NEC肠造瘘术后晚期关瘘比早期关瘘能为患儿带来更大的益处。

Timing of stoma closure after necrotizing enterocolitis in neonates

Objective Most neonates with necrotizing enterocolitis （NEC） requiring bowel resection and enterostomy. But the optimal timing of ostomy closure is a matter of debate. The purpose of this study was to determine the ideal time for stoma closure in infants with necrotizing enterocolitis. Methods This study retrospectively analyzed the data of infants undergoing necrotic intestinal resection and enterostomy due to NEC from August 2010 to January 2019 in Shenzhen Children's Hospital Neonatal Surgery. For analysis, we define early closure （EC） as 8 weeks （including 8 weeks） after enterostomy, and late closure （LC） as 8 weeks after enterostomy. Results Of the 58 children, 35 were male and 23 were female. The surgical indication was 40 cases of pneumoperitoneum and 18 cases of infections that could not be controlled by conservative treatment, of which 27 cases were early closure （EC） and 31 cases were late closure （LC）. 18 patients in the EC group required ventilator support （66.67%）, while 10 patients in the LC group （32.26%） （P<0.05）. The EC group required longer bowels than the LC group External nutritional support; and the length of hospital stay in the EC group was much longer than that in the LC group. Thirteen patients underwent reoperation for adhesion intestinal obstruction （of which 7 cases, LC group 6 cases）. In the EC group, 4 patients had poor postoperative incision healing, 2 patients died of sepsis, and 1 patients died of short bowel syndrome and severe malnutrition. All patients in the LC group recovered well after surgery and all survived. Conclusion This study suggests that the late stoma closure after NEC enterostomy is significantly better than the early closure.