Gao Jiafang, Lai Dengming, Tou Jinfa
Department of Neonatal Surgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Neonatal Surgery Group of the Pediatric Surgery Branch, Chinese Medical Association, Beijing, China.
World J Pediatr Surg. 2023 Aug 8;6(4):e000588. doi: 10.1136/wjps-2023-000588. eCollection 2023.
The aim of this study was to identify the state of surgical treatment of neonatal necrotizing enterocolitis (NEC) in China.
A total of 246 delegates (88.0% senior surgeons) completed a survey sent by the Neonatal Surgery Group of the Pediatric Surgery Branch of the Chinese Medical Association in 2022. Five centers were eliminated due to lack of experience.
Generally, 38.2% of surgeons work in centers where more than 20 cases of surgical NEC are treated per year. A total of 81.3% of surgeons reported the use of ultrasonography; the most used biomarkers were white blood cell count (95.9%), C-reactive protein (93.8%), and procalcitonin (76.3%). Most surgeons (80.9%) used a combination of two (67.2%) antibiotics or single (29.5%) antibiotic for a treatment period of 7-14 days, and most used antibiotics were carbapenems (73.9%), penicillin and cephalosporins (56.0%). Patients are issued the fasting order for 5-7 days by nearly half surgeons (49.8%) for conservative treatment. 70.1% of surgeons deemed that the most difficult decision was to evaluate the optimal timing of surgery. Most surgeons (76.3%) performed diagnostic aspiration of peritoneal fluid. Laparoscopy was performed for the diagnosis and/or treatment of NEC by 40.2% of surgeons. A total of 53.5% of surgeons reported being able to identify localized intestinal necrosis preoperatively. Surgeons relied the most on pneumoperitoneum (94.2%) and failure of conservative treatment (88.8%) to evaluate the surgical indications. At laparotomy, surgical treatments vary according to NEC severity. Infants are fasted for 5-7 days by 55.2% of surgeons postoperatively. Most surgeons (91.7%) followed up with patients with NEC after discharge for up to 5 years (53.8%).
The most difficult aspect of surgical NEC is evaluating the timing of surgery, and surgeons in the children's specialized hospitals are experienced. The treatment of NEC totalis is controversial, and the indications for laparoscopy need to be further clarified. More multicenter prospective studies are needed to develop surgical guidelines in the future.
本研究旨在明确中国新生儿坏死性小肠结肠炎（NEC）的外科治疗现状。
2022年，共有246名代表（88.0%为资深外科医生）完成了中华医学会小儿外科学分会新生儿外科学组发放的一项调查问卷。因经验不足，剔除了5个中心的数据。
总体而言，38.2%的外科医生所在中心每年治疗超过20例外科NEC病例。共有81.3%的外科医生报告使用超声检查；最常用的生物标志物是白细胞计数（95.9%）、C反应蛋白（93.8%）和降钙素原（76.3%）。大多数外科医生（80.9%）使用两种抗生素联合（67.2%）或单一抗生素（29.5%）进行治疗，疗程为7 - 14天，最常用的抗生素是碳青霉烯类（73.9%）、青霉素和头孢菌素（56.0%）。近半数外科医生（49.8%）对保守治疗的患者下达禁食5 - 7天的医嘱。70.1%的外科医生认为最困难的决策是评估最佳手术时机。大多数外科医生（76.3%）进行了腹腔穿刺液诊断性抽吸。40.2%的外科医生采用腹腔镜进行NEC的诊断和/或治疗。共有53.5%的外科医生报告能够在术前识别局限性肠坏死。外科医生最依赖气腹（94.2%）和保守治疗失败（88.8%）来评估手术指征。在剖腹手术中，手术治疗根据NEC严重程度而异。55.2%的外科医生在术后让婴儿禁食5 - 7天。大多数外科医生（91.7%）对NEC患儿出院后随访长达5年（53.8%）。
外科NEC最困难的方面是评估手术时机，儿童医院的外科医生经验丰富。全小肠坏死性小肠结肠炎的治疗存在争议，腹腔镜手术的指征需要进一步明确。未来需要更多的多中心前瞻性研究来制定外科治疗指南。
