Houben Christoph Heinrich, Chan Kin Wai Edwin, Mou Jennifer Wai Cheung, Tam Yuk Him, Lee Kim Hung
Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong, China.
J Neonatal Surg. 2016 Jul 3;5(3):28. doi: 10.21699/jns.v5i3.379. eCollection 2016 Jul-Sep.
Evaluating the long-term outcome of the surgical management for intestinal strictures developing after necrotizing enterocolitis (NEC).
This is a retrospective study of all patients with an intestinal stricture after completion of conservative management for NEC. They were treated during the eight years period from 1st January 2008 to 31st December 2015.
During the study period 67 infants had an operation for NEC, of which 55 had emergency surgery. The remaining twelve infants (6 males) had a stricture and were included in the study group. Their median gestational age was 35 (range 27-40) weeks and the median weight was 2180 (range 770 - 3290) g. The onset of NEC was seen at a median of 2 (range 1- 47) days. The median peak C-reactive protein (CRP) level was 73.1 (range 25.2 - 232) mg/dl. Isolated strictures were seen in 9 (75%) patients. Two-third of all strictures (n=15) were located in the colon. Surgery was done at a median of 5 (range 3 - 13) weeks after diagnosing NEC. Primary anastomosis was the procedure of choice; only one needed a temporary colostomy. This cohort had no mortality during a median follow up of 6.25 (range 0.5 - 7.6) years, whilst the overall death rate for NEC was 15 (22 %). Two fifth of the group developed a neurological / sensory impairment.
One fifth of the surgical workload for NEC is related to post-NEC strictures. Most strictures are located in the colonic region. In the long-term no mortality and no surgical co-morbidities were observed.
评估坏死性小肠结肠炎（NEC）后发生的肠道狭窄手术治疗的长期疗效。
这是一项对所有在NEC保守治疗完成后出现肠道狭窄患者的回顾性研究。他们在2008年1月1日至2015年12月31日的八年期间接受治疗。
在研究期间，67例婴儿因NEC接受手术，其中55例接受急诊手术。其余12例婴儿（6例男性）出现狭窄并被纳入研究组。他们的中位胎龄为35（范围27 - 40）周，中位体重为2180（范围770 - 3290）克。NEC发病的中位时间为2（范围1 - 47）天。C反应蛋白（CRP）水平的中位峰值为73.1（范围25.2 - 232）mg/dl。9例（75%）患者出现孤立性狭窄。所有狭窄的三分之二（n = 15）位于结肠。在诊断NEC后中位5（范围3 - 13）周进行手术。首选的手术方式是一期吻合术；只有1例需要临时结肠造口术。该队列在中位随访6.25（范围0.5 - 7.6）年期间无死亡，而NEC的总体死亡率为15（22%）。该组中有五分之二的患者出现神经/感觉障碍。
NEC手术工作量的五分之一与NEC后狭窄有关。大多数狭窄位于结肠区域。长期来看，未观察到死亡和手术相关的合并症。
