Kosloske A M, Musemeche C A, Ball W S, Ablin D S, Bhattacharyya N
Department of Surgery and Pediatrics, University of New Mexico School of Medicine, Albuquerque 87106.
AJR Am J Roentgenol. 1988 Oct;151(4):771-4. doi: 10.2214/ajr.151.4.771.
To investigate whether radiographic findings could be used to predict pan-necrosis (necrosis of 75% or more of the jejunum, ileum, and colon), we reviewed the serial abdominal radiographs and clinical records of 147 infants with necrotizing enterocolitis. Pan-necrosis occurred in 29 infants (20%) and was always fatal. The presence and degree of pneumatosis intestinalis, pneumoperitoneum and portal venous gas were studied. Pan-necrosis occurred least frequently in infants with mild or moderate pneumatosis intestinalis (8% and 12%, respectively), and with moderate frequency in those with pneumoperitoneum (33%). Pan-necrosis was found most frequently in infants with severe pneumatosis intestinalis (56%), portal venous gas (61%), or the combination of severe pneumatosis intestinalis and portal venous gas (79%). The mortality rates in these three groups were 63%, 65%, and 86%, respectively. Thus, infants with the worst outcome (those who develop pan-necrosis) can be identified on plain films by detection of severe pneumatosis intestinalis and portal venous gas.
为了研究影像学表现是否可用于预测全肠坏死（空肠、回肠和结肠75%或更多发生坏死），我们回顾了147例坏死性小肠结肠炎婴儿的系列腹部X线片和临床记录。29例婴儿（20%）发生了全肠坏死，且均死亡。研究了肠壁积气、气腹和门静脉积气的存在情况及程度。全肠坏死在轻度或中度肠壁积气的婴儿中发生率最低（分别为8%和12%），在气腹婴儿中发生率中等（33%）。全肠坏死在重度肠壁积气的婴儿中最常见（56%），在门静脉积气的婴儿中也最常见（61%），在重度肠壁积气和门静脉积气同时存在的婴儿中最常见（79%）。这三组的死亡率分别为63%、65%和86%。因此，通过检测重度肠壁积气和门静脉积气，可在平片上识别出预后最差（发生全肠坏死）的婴儿。
