Stokes Sean M, Iocono Joseph A, Draus John M
Department of Surgery, Division of Pediatric Surgery, University of Kentucky, Lexington, Kentucky, USA.
Am Surg. 2014 Sep;80(9):851-4.
Complicated necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) are major causes of mortality. We hypothesized that peritoneal drainage (PD) is more efficacious in SIP. Newborn infants with intestinal perforation treated with PD at our institution between 2007 and 2012 were divided into two groups: Group 1, infants with complicated NEC (n = 19), and Group 2, infants with SIP (n = 15). In Group 1, median birth weight was 705 g; median gestational age was 25.9 weeks. Median age at PD was 24 days. Six required laparotomy. Median time from PD to enteral feeds was 22.5 days. In Group 2, median birth weight was 685 g; median gestational age was 25.3 weeks. Median age at PD was 5 days. Two required laparotomy. Median time from PD to enteral feeds was 16 days. In Group 1, eight patients survived to discharge; median length of hospital stay (LOS) was 104.5 days. In Group 2, eight survived; median LOS was 109.5 days. Neither outcome was statistically significant (P = 0.73 and 0.878, respectively). Management of premature infants with intestinal perforation remains challenging. Mortality is high. Between our cohorts, there were no differences in regard to PD as definitive therapy, survival, and LOS.
复杂性坏死性小肠结肠炎（NEC）和自发性肠穿孔（SIP）是主要的死亡原因。我们推测腹膜引流（PD）治疗SIP更有效。2007年至2012年在我们机构接受PD治疗的肠穿孔新生儿被分为两组：第1组，患有复杂性NEC的婴儿（n = 19），第2组，患有SIP的婴儿（n = 15）。在第1组中，出生体重中位数为705克；胎龄中位数为25.9周。PD时的年龄中位数为24天。6例需要剖腹手术。从PD到肠内喂养的中位时间为22.5天。在第2组中，出生体重中位数为685克；胎龄中位数为25.3周。PD时的年龄中位数为5天。2例需要剖腹手术。从PD到肠内喂养的中位时间为16天。在第1组中，8例患者存活至出院；住院时间（LOS）中位数为104.5天。在第2组中，8例存活；LOS中位数为109.5天。两种结果均无统计学意义（P分别为0.73和0.878）。对肠穿孔早产儿的管理仍然具有挑战性。死亡率很高。在我们的队列之间，作为确定性治疗的PD、生存率和LOS方面没有差异。
