Wolf Lea, Gfroerer Stefan, Fiegel Henning, Rolle Udo
Department of Pediatric Surgery, University Hospital Frankfurt, Goethe-University Frankfurt am Main, Frankfurt 60590, Germany.
World J Clin Cases. 2018 Dec 26;6(16):1101-1110. doi: 10.12998/wjcc.v6.i16.1101.
To evaluate the occurrence and severity of enterostomy complications in newborns suffering from different intestinal disorders.
A 10-year retrospective cohort study (2008-2017) investigated newborns that underwent enterostomy formation and reversal for different intestinal disorders. Only infants less than 28 d old at the time of enterostomy creation were included in the study (corrected age was applied in the cases of preterm neonates). The patients were divided into two groups according to their underlying diseases. Group 1 included infants suffering from necrotizing enterocolitis (NEC), whereas Group 2 included newborns diagnosed with intestinal disorders other than NEC, such as meconium obstruction, anorectal malformation, focal intestinal perforation, ileus, intestinal atresia and volvulus. The primary outcome measure was enterostomy-related morbidity. The data were analyzed statistically using Pearson's χ test or Fisher's exact test for categorical variables and the Wilcoxon-Mann-Whitney -Test for continuous variables.
In total, 76 infants met the inclusion criteria and were evaluated for enterostomy-related complications. Neither group showed significant differences regarding gender, gestational age, weight at birth or weight at enterostomy formation. Infants suffering from NEC (Group 1) were significantly older at enterostomy formation than the neonates of Group 2 [median (range), 11 (2-75) d 4 (1-101) d, = 0.004)]. Significantly more ileostomies were created in Group 1 [47 (92.2%) 16 (64.0%), = 0.007], whereas colostomies were performed significantly more often in Group 2 [2 (3.9%) 8 (32.0%), = 0.002]. The initiation of enteral nutrition after enterostomy was significantly later in Group 1 infants than in Group 2 infants [median (range), 5 (3-13) 3 (1-9), < 0.001]. The overall rate of one or more complications in patients of both groups after enterostomy formation was 80.3%, with rates of 86.3% in Group 1 and 68.0% in Group 2 ( = 0.073). Most patients suffered from two complications (23.7%). Four or more complications occurred in 21.6% of the infants in Group 1 and in 12.0% of the infants in Group 2 ( = 0.365). Following enterostomy closure, at least one complication was observed in 26.0% of the patients (30.6% in Group 1 and 16.7% in Group 2, = 0.321). The occurrence of complications was not significantly different between neonates with NEC and infants with other intestinal disorders. 48 (65.8%) patients required no treatment or only pharmacological treatment for the complications that occurred [Clavien-Dindo-Classification (CDC) < III], while 25 (34.2%) required surgery to address the complications (CDC ≥ III). Early reversal of the enterostomy was performed significantly more often ( = 0.003) and the time to full enteral nutrition after closure was significantly longer [median (range), 7 (3-87) d 12 (5-93) d, = 0.006] in infants with a CDC grading ≥ III than in infants with a CDC grading < III.
Complications occur in almost all infants with enterostomies. The majority of these complications are minor and do not require surgical treatment. There is a clear trend that neonates with NEC have a higher risk for developing complications than those without NEC.
评估患有不同肠道疾病的新生儿肠造口术并发症的发生率及严重程度。
一项为期10年的回顾性队列研究（2008 - 2017年）调查了因不同肠道疾病接受肠造口术建立及还纳的新生儿。仅纳入造口术时年龄小于28天的婴儿（早产儿采用矫正年龄）。根据基础疾病将患者分为两组。第1组包括患有坏死性小肠结肠炎（NEC）的婴儿，而第2组包括诊断为除NEC外其他肠道疾病的新生儿，如胎粪梗阻、肛门直肠畸形、局灶性肠穿孔、肠梗阻、肠闭锁和肠扭转。主要观察指标为与肠造口术相关的发病率。使用Pearson卡方检验或Fisher精确检验对分类变量进行统计学分析，使用Wilcoxon - Mann - Whitney检验对连续变量进行分析。
共有76例婴儿符合纳入标准并接受了与肠造口术相关并发症的评估。两组在性别、胎龄、出生体重或造口术形成时的体重方面均无显著差异。患有NEC的婴儿（第1组）造口术形成时的年龄显著大于第2组新生儿[中位数（范围），11（2 - 75）天对4（1 - 101）天，P = 0.004]。第1组造口术形成回肠造口的比例显著更高[47（92.2%）对16（64.0%），P = 0.007]，而第2组结肠造口术实施的频率显著更高[2（3.9%）对8（32.0%），P = 0.002]。第1组婴儿造口术后肠内营养开始时间显著晚于第2组婴儿[中位数（范围），5（3 - 13）天对3（1 - 9）天，P < 0.001]。两组患者造口术形成后发生一种或多种并发症的总体发生率为80.3%，第1组为86.3%，第2组为68.0%（P = 0.073）。大多数患者出现两种并发症（23.7%）。第1组21.6%的婴儿和第2组12.0%的婴儿发生四种或更多并发症（P = 0.365）。造口还纳后，26.0%的患者观察到至少一种并发症（第1组为30.6%，第2组为16.7%，P = 0.321）。患有NEC的新生儿与患有其他肠道疾病的婴儿之间并发症的发生率无显著差异。48例（65.8%）患者发生的并发症无需治疗或仅需药物治疗[Clavien - Dindo分类（CDC）<Ⅲ]，而25例（34.2%）患者需要手术处理并发症（CDC≥Ⅲ）。与CDC分级<Ⅲ的婴儿相比，CDC分级≥Ⅲ的婴儿肠造口术早期还纳的实施频率显著更高（P = 0.003），还纳后完全肠内营养的时间显著更长[中位数（范围），7（3 - 87）天对12（5 - 93）天，P = 0.006]。
几乎所有接受肠造口术的婴儿都会发生并发症。这些并发症大多数较轻微，无需手术治疗。有明显趋势表明，患有NEC的新生儿发生并发症的风险高于未患NEC的新生儿。
