多灶性坏死性小肠结肠炎“夹闭与丢弃”技术的治疗结果

Outcomes of the "clip and drop" technique for multifocal necrotizing enterocolitis.

作者信息

Ron Ori, Davenport Mark, Patel Shailesh, Kiely Edward, Pierro Agostino, Hall Nigel J, Ade-Ajayi Niyi

机构信息

Department of Pediatric Surgery, King's College Hospital NHS Trust, SE5 9RS London, United Kingdom.

出版信息

J Pediatr Surg. 2009 Apr;44(4):749-54. doi: 10.1016/j.jpedsurg.2008.09.031.

DOI:10.1016/j.jpedsurg.2008.09.031

PMID:19361635

Abstract

BACKGROUND

The "clip and drop" (CD) has been proposed as a useful strategy in the management of severe multifocal necrotizing enterocolitis (NEC). There is little published data on clinical outcomes after this intervention. We report a 2-center experience with this technique.

METHODS

A retrospective review of infants who underwent CD between 1998 and 2006 at 2 tertiary pediatric surgery centers. Data recorded included intestinal resections, interval between laparotomies, anastomoses at subsequent surgery, time to full feeds, and complications including mortality. Data are reported as median with ranges.

RESULTS

Thirteen infants (7 male, 6 female) with a birth weight of 811 (514-2110) g underwent CD of up to 5 bowel segments. In 8 of 9 early survivors, all CD segments were viable. Six patients (46%) were alive at 29 (9-96) months. Survivors underwent 4 (3-4) laparotomies and 4 (2-6) bowel anastomoses and had intestinal continuity restored at 67 (51-162) days.

CONCLUSIONS

With multiple interventions, half the infants in this high-risk group survived and achieved full enteral feeds. The CD is a valuable technique in a selected group of infants with fulminant NEC.

摘要

背景

“夹闭并切除”（CD）已被提议作为重症多灶性坏死性小肠结肠炎（NEC）治疗中的一种有用策略。关于这种干预后的临床结果，发表的数据很少。我们报告了在两个中心应用该技术的经验。

方法

对1998年至2006年期间在两家三级儿科手术中心接受CD治疗的婴儿进行回顾性研究。记录的数据包括肠切除术、剖腹手术间隔时间、后续手术中的吻合情况、完全经口喂养时间以及包括死亡率在内的并发症。数据以中位数及范围表示。

结果

13例婴儿（7例男性，6例女性）出生体重为811（514 - 2110）g，接受了多达5个肠段的CD治疗。9例早期存活者中有8例，所有CD段均存活。6例患者（46%）在29（9 - 96）个月时存活。存活者接受了4（3 - 4）次剖腹手术和4（2 - 6）次肠吻合术，肠连续性在67（51 - 162）天恢复。