新生儿坏死性小肠结肠炎的影像学表现预测手术时机。
Imaging manifestations of neonatal necrotizing enterocolitis to predict timing of surgery.
机构信息
Departments of Hospital Infection Administration, Children's Hospital, Capital Institute of Pediatrics, Beijing, China.
Departments of Neonatal General Surgery, Children's Hospital, Capital Institute of Pediatrics, Beijing, China.
出版信息
Turk J Pediatr. 2022;64(4):632-639. doi: 10.24953/turkjped.2021.5048.
BACKGROUND
To find the predictor of optimal surgical timing for neonatal necrotizing enterocolitis (NEC) patients by analyzing the risk factors of conservative treatment and surgical therapy.
METHODS
Data were collected from 184 NEC patients (Surgery, n=41; conservative treatment, n=143) between the years 2015 and 2019. Data were analyzed by univariate analysis, and multivariate binary logistic regression analysis.
RESULTS
Univariate analysis showed that statistically significant differences between the surgery and conservative treatment groups. The results of multivariate Logistic regression analysis indicated intestinal wall thickening by B-ultrasound and gestational age were independent factors to predict early surgical indications of NEC (p < 0.05). The true positive rate, false positive rate, true negative rate and false negative rate in the diagnosis of necrotic bowel perforation guided by DAAS (Duke abdominal X-ray score) ≥7 and MD7 (seven clinical metrics of metabolic derangement) ≥3 were 12.8%, 0.0%, 100.0% and 87.2%, respectively.
CONCLUSIONS
In summary, the ultrasound examination in NEC children showing thickening intestinal wall and poor intestinal peristalsis indicated for early operation.
背景
通过分析新生儿坏死性小肠结肠炎（NEC）保守治疗和手术治疗的危险因素，寻找最佳手术时机的预测因子。
方法
收集了 2015 年至 2019 年期间 184 例 NEC 患儿（手术组，n=41；保守治疗组，n=143）的数据。采用单因素分析和多因素二项逻辑回归分析。
结果
单因素分析显示，手术组与保守治疗组之间存在统计学差异。多因素 Logistic 回归分析表明，超声检查肠壁增厚和胎龄是预测 NEC 早期手术指征的独立因素（p<0.05）。DAAS（杜克腹部 X 线评分）≥7 和 MD7（代谢紊乱的 7 项临床指标）≥3 指导下坏死性肠穿孔的诊断的真阳性率、假阳性率、真阴性率和假阴性率分别为 12.8%、0.0%、100.0%和 87.2%。
结论
综上所述，NEC 患儿超声检查肠壁增厚、肠蠕动不良提示早期手术。
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