摘要
目的:探讨新生儿坏死性小肠结肠炎(NEC)后肠狭窄合并先天性巨结肠(HD)的诊治经验。方法:回顾性分析诊治的112例NEC患儿临床资料,共计37例肠狭窄患儿,按狭窄部位分为两组:脾曲近端狭窄组(PSCS)18例和脾曲远端狭窄组(DSCS)19例。收集患儿临床资料,分别通过直肠壁吸附活检术、术后病理学查找直肠末端和狭窄段肠管神经节细胞数量诊断是否合并先天性巨结肠。术后随访腹胀,便秘、小肠结肠炎并发症发生情况。结果:NEC合并HD共5例,占总NEC患儿4.5%,HD在NEC后肠狭窄中发病率为13.5%。NEC后最早出现肠狭窄时间为38 d,主要病变部位为小肠,最长时间204 d,病变部位主要为升结肠和横结肠。狭窄段肠管肠壁僵硬,增厚,管腔闭塞,闭塞管腔之间内见大量脓液,系膜血管闭塞,部分系膜缺失。直肠壁吸附术检查以及肠狭窄段病理检查发现PSCS组直肠神经节细胞与DSCS组神经节细胞比较,差异有统计学意义(P<0.05)。PSCS组诊断HD 1例,DSCS组诊断HD 4例,两组比较,差异无统计学意义(P>0.05)。所有患儿术后随访1～3年,两组患儿术后便秘、腹胀、小肠结肠炎并发症的发生率以及体重增长比较,差异无统计学意义(P>0.05)。结论:NEC后肠狭窄患儿因警惕合并HD的可能,再次手术之前通过直肠壁吸附活检术可进一步明确诊断。
Objective To explore the management of intestinal stenosis after necrotizing enterocolitis(NEC)associated with Hirschsprung's disease(HD). Method Clinic data of 112 cases was studied retrospectively.A total of 37 children with intestinal stenosis were divided into two groups according to the location of stenosis: proximal splenic curvature stenosis group(PSCS,n=18)and distal splenic curvature stenosis group(DSCS,n=19).Diagnosis of Hirschsprung's disease by quantitative ganglion cells of distal rectum and intestinal stenosis were made by suction rectal biopsy and pathology.Abdominal distention,constipation and enterocolitis were followed up after operation. Results There were 5 cases of NEC combined with HD,accounting for 4.5% of total NEC patients and 13.5% of HD patients in intestinal stenosis after NEC progress.The earliest occurrence of intestinal stenosis after NEC was 38 days.The main lesion site was small intestine.The longest time was 204 days.The lesion site was mainly ascending colon and transverse colon.The strictured intestinal wall was stiff and thicker,and the lumen was occluded.A lot of abscess was seen between the atresias.The mesenteric vessels were occluded and some of the mesenteries were missing.The results of suction rectal biopsy and pathological examination of intestinal stenosis showed that PSCS group was significantly more than DSCS group,the difference was statistically significant(P<0.05).There were 1 case of HD in PSCS group and 4 cases in DSCS group,there was no significant difference between the two groups(P>0.05).All the children were followed up for 1 to 3 years.There was no significant difference in the incidence of constipation,abdominal distension,enterocolitis and weight gain between the two groups(P>0.05). Conclusion The diagnosis of intestinal stenosis after NEC can be confirmed by suction rectal biopsy before reoperation because of the possibility of associate with HD.
作者
郑泽兵
张帆
刘远梅
高明娟
汤成艳
金祝
ZHENG Ze-bing;ZHANG Fan;LIU Yuan-mei(Department of Pediatric general thoracic urology Surgery,The affiliated hospital of Zunyi Medical University,Zunyi 563000,China)
出处
《吉林医学》
CAS
2019年第5期930-933,共4页
Jilin Medical Journal
基金
贵州省科技厅联合基金资助[黔科合LH字(2017)7100号]
关键词
新生儿坏死性小肠结肠炎
先天性巨结肠
肠狭窄
并发症
Necrotizing enterocolitis(NEC)
Hirschsprung's disease(HD)
Intestinal stenosis
Complication
