Guner Yigit S, Chokshi Nikunj, Petrosyan Mikael, Upperman Jeffrey S, Ford Henri R, Grikscheit Tracy C
Department of Surgery, Childrens Hospital Los Angeles, and the Keck School of Medicine, University of Southern California, Los Angeles, California 90027, USA.
Semin Pediatr Surg. 2008 Nov;17(4):255-65. doi: 10.1053/j.sempedsurg.2008.07.004.
Necrotizing enterocolitis (NEC) is a devastating illness that predominantly affects premature neonates. The mortality associated with this disease has changed very little during the last two decades. Neonates with NEC fall into two categories: those who respond to medical management alone and those who require surgical treatment. The disease distribution may be focal, multifocal, or panintestinal. Surgical treatment should therefore be based on disease presentation. Recent studies have added significant insight into our understanding of the pathogenesis of NEC. Several groups have shown that upregulation of nitric oxide plays an integral role in the development of epithelial injury in NEC. As a result, some treatment strategies have been aimed at abrogating the toxic effects of nitric oxide. In addition, several investigators have reported the cytoprotective effect of epidermal growth factor, which is found in high levels in breast milk, on the intestinal epithelium. Thus, fortification of infant formula with specific growth factors could soon become a preferred strategy to accelerate intestinal maturation in the premature neonate to prevent the development of NEC. One of the most devastating complications of NEC is the development of short bowel syndrome (SBS). The current treatment of SBS involves intestinal lengthening procedures or bowel transplantation. A novel emerging method for treating SBS involves the use of tissue-engineered intestine. In laboratory animals, tissue-engineered small intestine has been shown to be successful in treating intestinal failure. This article examines recent data regarding surgical treatment options for NEC as well as emerging treatment modalities.
坏死性小肠结肠炎（NEC）是一种主要影响早产儿的严重疾病。在过去二十年中，与这种疾病相关的死亡率变化很小。患有NEC的新生儿分为两类：仅对药物治疗有反应的新生儿和需要手术治疗的新生儿。疾病分布可能是局灶性、多灶性或全肠道性的。因此，手术治疗应基于疾病表现。最近的研究为我们对NEC发病机制的理解提供了重要的见解。几个研究小组表明，一氧化氮的上调在NEC上皮损伤的发展中起着不可或缺的作用。因此，一些治疗策略旨在消除一氧化氮的毒性作用。此外，一些研究人员报告了表皮生长因子（在母乳中含量很高）对肠上皮的细胞保护作用。因此，用特定生长因子强化婴儿配方奶粉可能很快成为加速早产儿肠道成熟以预防NEC发生的首选策略。NEC最严重的并发症之一是短肠综合征（SBS）的发生。目前对SBS的治疗包括肠道延长手术或肠移植。一种新兴的治疗SBS的方法涉及使用组织工程肠道。在实验动物中，组织工程小肠已被证明在治疗肠道衰竭方面是成功的。本文探讨了有关NEC手术治疗选择以及新兴治疗方式的最新数据。
