Petty John K, Ziegler Moritz M
Department of Surgery, The Children's Hospital and The University of Colorado School of Medicine, Denver, Colorado 80218, USA.
Semin Pediatr Surg. 2005 Aug;14(3):191-8. doi: 10.1053/j.sempedsurg.2005.05.009.
Necrotizing enterocolitis (NEC) is the leading cause of short-bowel syndrome (SBS) in infancy. Studies on the acute medical and surgical management of NEC have traditionally focused on short-term morbidity and mortality, with less emphasis on long-term outcomes. Acute surgical management of NEC involves the often competing priorities of controlling sepsis and preserving bowel length. Bowel-preserving strategies for NEC, designed to limit SBS, are based on peritoneal drainage, limited resection, or a combination of both. Drainage-based strategies are generally favored in smaller neonates, while laparotomy-based strategies are favored in larger patients, especially those with a more limited extent of intestinal injury. Comparisons of drainage-based approaches and resection-based approaches are limited by confounding variables, and neither approach is clearly superior with regard to subsequent SBS. These traditional as well as more creative approaches to bowel preservation have application in NEC, yet they depend on a series of patient and treatment characteristics that include the ability of diseased but viable bowel to recover both absorptive and motility function after acute NEC, the ability of the infant to tolerate appropriately drained intraperitoneal contamination, and the ability of the injured intestine to subsequently undergo intestinal adaptive change. In addition, there are a series of operative options that have been designed to mitigate the impact of SBS once it is established. These procedures are not uniquely applied exclusively for NEC-induced SBS. However, strategies that slow intestinal transit, improve peristaltic function, or enhance mucosal absorptive function each have application in the management of SBS.
坏死性小肠结肠炎（NEC）是婴儿期短肠综合征（SBS）的主要原因。传统上，关于NEC急性药物和手术治疗的研究主要集中在短期发病率和死亡率，而较少关注长期预后。NEC的急性手术治疗涉及控制败血症和保留肠长度这两个往往相互冲突的优先事项。旨在限制SBS的NEC保肠策略基于腹腔引流、有限切除或两者结合。基于引流的策略通常在较小的新生儿中更受青睐，而基于剖腹手术的策略在较大的患者中更受青睐，尤其是那些肠损伤范围较有限的患者。基于引流的方法和基于切除的方法的比较受到混杂变量的限制，并且就随后的SBS而言，两种方法都没有明显优势。这些传统以及更具创造性的保肠方法在NEC中都有应用，但它们取决于一系列患者和治疗特征，包括患病但仍存活的肠在急性NEC后恢复吸收和运动功能的能力、婴儿耐受适当引流的腹腔内污染的能力以及受损肠随后进行肠道适应性改变的能力。此外，有一系列手术选择旨在减轻SBS一旦形成后的影响。这些手术并非专门仅用于NEC引起的SBS。然而，减缓肠道运输、改善蠕动功能或增强黏膜吸收功能的策略在SBS的管理中都有应用。
