新生儿非计划二次手术原因分析及对策探讨

目的 探讨新生儿非计划二次手术的原因及预防措施,提高医疗技术水平,降低非计划二次手术率.方法 回顾性分析我院新生儿外科2005年01月至2014年12月非计划二次手术40例患儿的临床资料.40例新生儿中,男29例,女11例,平均年龄6.5d,平均住院时间26.2d,按再次手术与首次手术的时间间隔统计,平均间隔时间为11.4d.40例新生儿均为先天性肠道疾病术后,因各种原因行非计划二次手术,对其进行回顾性分析,探讨新生儿肠道疾病非计划二次手术的原因及预防治疗措施.结果 前五年非计划二次手术的发生率2.6％,近五年非计划二次手术的发生率1.7％,降低了0.9％.新生儿非计划二次手术发生原因主要是肠梗阻15例(37.5％)、吻合口漏6例(15.0％)、切口裂开7例(17.5％)、消化道穿孔7例(17.5％)、坏死性小肠结肠炎(NEC)3例(7.5％)、肠旋转不良肠再扭转2例(5.0％).40例中34例痊愈,5例自动出院,1例死亡.术后随访3个月,除2例坏死性小肠结肠炎患儿因低位肠梗阻再次入院手术治疗,其余患儿均生长发育良好.结论 非计划二次手术对患儿造成损害,加强围手术期的监测、规范手术操作可以有效降低其发生率.

Cause analyses and countermeasures of 40 neonates of unplanned second surgery

Objective To explore the causes and countermeasures for neonates of unplanned second surgery so as to raise the level of medical technology and lower the rate of unplanned second surgery.Methods Retrospective analyses were performed for 40 neonatal cases of unplanned second surgery for congenital intestinal disease from January 2005 to December 2014.There were 29 boys and 11 girls with a mean age 6.539 days.Their mean hospital stay was 26.2 days according to the mean interval of reoperation and initial operation at 11.4 days.Unplanned second surgery was performed for various reasons.And the causes and countermeasures of unplanned second surgery were analyzed.Results The rate of unplanned second surgery of past 5 years was 2.6％,1.7％ for recent 5 years and it declined by 0.9％.The causes of unplanned second surgery were intestinal obstruction (n =15,37.5％),anastomotic leakage (n =6,15.0％),anastomotic dehiscence (n =7,17.5％),perforation of digestive tract (n =7,17.5 ％),necrotizing enterocolitis (NEC) (n =3,7.5 ％),intestinal malrotation & torsion (n =2,5.0％).And the outcomes were healing (n =34),automatic discharge (n=5) and death (n=1).During a 3-month follow-up,except for 2 cases of NEC with low intestinal obstruction,the remainder recovered well.Conclusions Unplanned secondary surgery is harmful.And strengthening perioperative monitoring and standardizing operative procedures can effectively reduce its incidence.