肠内置管外引流术治疗新生儿坏死性小肠结肠炎的疗效分析

发布时间：2018-06-21 16:10

  本文选题：肠内置管外引流术 + 新生儿　； 参考：《东南大学学报(医学版)》2017年04期

【摘要】：目的:通过评价肠内置管外引流术治疗新生儿坏死性小肠结肠炎的临床疗效,探讨其临床应用前景。方法:选用2012年8月至2015年8月本院小儿外科重症监护室收治的由于肠道存在广泛病变而无法立即确认手术切除范围的80例坏死性小肠结肠炎新生儿作为研究对象,随机分为常规手术组和肠内置管外引流术组,各40例。常规手术组行常规手术治疗,肠内置管外引流术组采用肠内置管外引流术结合常规手术治疗。比较这两种手术方式治愈率的差异,术后6个月对痊愈的患儿进行定向回访,调查患儿术后体质量的改变情况、并发症的发生情况及预后情况。结果:肠内置管外引流术组患儿的治愈率为67.5%,明显高于常规手术组的47.5%(χ~2=3.274,P=0.070);肠内置管外引流术组患儿的手术时间为(55.78±10.94)min,显著低于常规手术组的(80.28±11.62)min(t=9.711,P=0.000);术后回访结果显示,常规手术组的患儿体质量为(5.89±0.94)kg,明显低于肠内置管外引流术组的(6.28±0.61)kg(t=2.176,P=0.033);术后常规手术组患儿排便异常发生率为68.4%,明显高于肠内置管外引流术组的37%(χ~2=4.394,P=0.036);术后常规手术组患儿不完全肠梗阻发生率为57.9%,明显高于肠内置管外引流术组的25.9%(χ~2=4.785,P=0.029)。手术后大于3处的肠穿孔以及循环的衰竭是影响治疗效果及预后的主要因素。结论:肠内置管外引流术治疗新生儿坏死性小肠结肠炎能够缩短手术时间,提高该病的手术治愈率,有效减少术后并发症的发生,值得在临床进一步推广。
[Abstract]:Objective: to evaluate the clinical effect of enteral catheterization and extracorporeal drainage for neonatal necrotizing enterocolitis. Methods: from August 2012 to August 2015, 80 neonates with necrotizing enterocolitis who were admitted to intensive care unit of pediatric surgery in our hospital were selected. They were randomly divided into routine operation group and enteral catheterization external drainage group with 40 cases each. Routine surgical treatment was performed in the routine operation group, and intestinal catheterization and external drainage combined with conventional surgical treatment in the intestinal catheterization group. The difference of the cure rate between the two methods was compared. The patients who were cured 6 months after the operation were interviewed by a targeted visit to investigate the changes of body mass, the occurrence of complications and the prognosis of the patients. Results: the cure rate of the children in the group of internal and external catheterization was 67.5, which was significantly higher than that in the group of routine operation (蠂 2 / 23.274) and the operative time was 55.78 卤10.94 / min, which was significantly lower than that in the group of routine operation (80.28 卤11.62min / 9.711P ~ (0.000), and the results of the postoperative follow-up showed that the operative time of the group was 55.78 卤10.94 / min, which was significantly lower than that of the group of routine operation (80.28 卤11.62min-1 / min). The body mass of the children in the routine operation group was 5.89 卤0.94kg, which was significantly lower than that in the external drainage group (6.28 卤0.61kg / kg), and the incidence of abnormal defecation was 68.4% in the routine operation group, which was significantly higher than that in the external drainage group (蠂 ~ 2 / 24.394) (蠂 ~ 2 / 24.394P ~ (0.036), and in the routine operation group (P < 0.036), the incidence of defecation abnormality in the routine operation group was 68.4%, which was significantly higher than that in the external drainage group (P < 0.05). The incidence of incomplete intestinal obstruction was 57.9%, which was significantly higher than that of 25.9% in the external drainage group. Intestinal perforation and circulatory failure more than 3 sites after operation are the main factors affecting the treatment effect and prognosis. Conclusion: the treatment of neonatal necrotizing enterocolitis with internal and external catheter drainage can shorten the operation time, improve the cure rate of the disease, and effectively reduce the incidence of postoperative complications, which is worthy of further promotion in clinical practice.
【作者单位】： 郑州儿童医院;
【基金】：河南省2013年基础与前沿技术研究计划项目(132300410251)
【分类号】：R722.1
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本文编号：2049407