早期、延期手术治疗新生儿坏死性小肠结肠炎对预后及肠梗阻风险的影响

目的观察早期、延期手术治疗新生儿坏死性小肠结肠炎对预后及肠梗阻风险的影响。 方法选取海口市妇幼保健院2015年1月至2017年2月收治的60例新生儿坏死性小肠结肠炎患儿，按随机数字表法分为A组与B组，各30例。两组均采取肠内置管外引流术，其中A组采取早期手术，B组采取延期手术，术后随访6个月。比较两组死亡率、并发症总发生率、随访期间排便异常、不完全肠梗阻发生率及随访结束时的体重。 结果A组总死亡率为10.00%，低于B组26.67%，差异无统计学意义（χ²=2.783，P=0.095）。A组未见并发症，B组并发症总发生率为26.67%，差异有统计学意义（χ²=7.067，P=0.008）。术后6个月，A组患儿体重为（7.02±1.15）Kg，显著高于B组（5.75±1.02）Kg （t=4.525，P=0.000）。两组排便异常发生率的差异无统计学意义（χ²=0.288，P=0.840）。A组不完全肠梗阻发生率为18.52%（5/27），显著低于B组50.00%（9/18）（χ²=5.860，P=0.015）。 结论肠内置管外引流术治疗新生儿坏死性小肠结肠炎可引流并减张肠管，减少肠内毒素吸收，并避免切除过多的肠管，可取得良好预后，且早期手术可进一步减少并发症，提高存活率，降低术后肠梗阻风险，值得推广。

Influence of early and delayed surgical treatment of neonatal necrotizing enterocolitis on prognosis and intestinal obstruction risk

ObjectiveTo observe the influence of early and delayed surgical treatment of neonatal necrotizing enterocolitis on the prognosis and the intestinal obstruction risk. MethodsA total of 60 cases of neonatal necrotizing enterocolitis in Maternal and Child Care Service Centre of Haikou City from January 2015 to February 2017 were randomly divided into observation group and control group, thirty cases in each group. Both groups were received enteral external catheter drainage. The group A was taken early surgery, and group B was taken delayed surgery. The patients were followed up for 6 months. The mortality, total complication rate were compared between the two groups. And the incidences of defecation, incomplete intestinal obstruction during follow-up, body weight at the end of follow-up were compared between the two groups. ResultsThe total mortality in group A was 10.00%, which was lower than 26.67% in group B, while the difference was not statistically significant (χ²=2.783, P=0.095). There was no complication in group A, and the total complication rate in group B was 26.67%. The difference was statistically significant (χ²=7.067, P=0.008). 6 months after surgery, the body weight of group A was (7.02±1.15) Kg, which was significantly higher than (5.75±1.02) Kg in group B (t=4.525, P=0.000). There was no significant difference in the incidence of defecation between the two groups (χ²=0.288, P=0.840). The incidence of incomplete intestinal obstruction in group A was 18.52% (5/27), which was significantly lower than 50.00% (9/18) in group B (χ²=5.860, P=0.015). ConclusionThe treatment of neonatal necrotizing enterocolitis by enteral external catheter drainage can drain and reduce tension of intestine, reduce the intestinal absorption of toxins, avoid excessive removal of the intestine, and achieve a good prognosis. Early surgery can further reduce the complications, therefore it can improve survival rate, reduce the risk of postoperative intestinal obstruction, which is worth promoting.