Rauh Jessica L, Reddy Menaka N, Santella Nicole L, Ellison Maryssa A, Weis Victoria G, Zeller Kristen A, Garg Parvesh M, Ladd Mitchell R
Wake Forest School of Medicine, General Surgery, Winston Salem, NC, USA.
Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC, USA.
Am Surg. 2024 Sep;90(9):2279-2284. doi: 10.1177/00031348241256054. Epub 2024 May 24.
The optimal time for intervention in surgical necrotizing enterocolitis (sNEC) remains to be elucidated. Surgical management varies between peritoneal drain (PD), laparotomy (LAP), and PD with subsequent LAP (PD + LAP). We propose that some infants with surgical NEC benefit from late (>48 h) operative intervention to allow for resuscitation.
A retrospective comparison of clinical information in infants with sNEC from 2012 to 2022 was performed. Early intervention was defined as less than 48 hours from time of NEC diagnosis to surgical intervention.
118 infants were identified, 92 underwent early intervention (62 LAP; 22 PD; 8 PD + LAP) and 26 underwent late intervention (20 LAP; 2 PD; 4 PD + LAP). Infants with early intervention were diagnosed younger (DOL 8 [6, 15] vs 20 [11, 26]; =< .05) with more pneumoperitoneum (76% vs 23%; =< .05). The early intervention group had a higher mortality (35% vs 15%; =< .05). When excluding infants with pneumoperitoneum, the early intervention group had a higher mortality rate (10/22 (45%), 4/26 (15%); < .05) and had more bowel resected (29 ± 17 cm vs 9 ± 8 cm; < .05), with the same number of patients scoring above 3 on the MD7 criteria.
Infants with NEC who underwent early surgical intervention had a higher mortality and more bowel resected. While this study has a provocative finding, it is severely limited by the non-specific 48-hour cut off. However, our data suggests that a period of medical optimization may improve outcomes in infants with sNEC and thus more in-depth studies are needed.
外科坏死性小肠结肠炎（sNEC）的最佳干预时机仍有待阐明。手术管理方式包括腹腔引流（PD）、剖腹手术（LAP）以及先腹腔引流随后剖腹手术（PD + LAP）。我们认为，一些患有外科坏死性小肠结肠炎的婴儿可从延迟（>48小时）手术干预中获益，以便进行复苏。
对2012年至2022年患有sNEC的婴儿的临床信息进行回顾性比较。早期干预定义为从NEC诊断到手术干预的时间少于48小时。
共确定118例婴儿，92例接受早期干预（62例行剖腹手术；22例行腹腔引流；8例行腹腔引流+剖腹手术），26例接受延迟干预（20例行剖腹手术；2例行腹腔引流；4例行腹腔引流+剖腹手术）。接受早期干预的婴儿诊断时年龄更小（出生后8天[6, 15] vs 20天[11, 26]；P<=.05），气腹更多（76% vs 23%；P<=.05）。早期干预组死亡率更高（35% vs 15%；P<=.05）。排除有气腹的婴儿后，早期干预组死亡率更高（10/22（45%），4/26（15%）；P<.05），切除的肠段更多（29±17厘米 vs 9±8厘米；P<.05），在MD-7标准评分高于3分的患者数量相同。
接受早期手术干预的坏死性小肠结肠炎婴儿死亡率更高，切除的肠段更多。虽然本研究有一个引人深思的发现，但它受到非特异性的48小时界限的严重限制。然而，我们的数据表明，一段时间的医学优化可能会改善患有sNEC婴儿的预后，因此需要更深入的研究。
