Born M, Holgersen L O, Shahrivar F, Stanley-Brown E, Hilfer C
J Pediatr Surg. 1985 Aug;20(4):461-3. doi: 10.1016/s0022-3468(85)80242-6.
A study to determine the value of contrast enemas in diagnosing and managing intestinal strictures following nonoperative treatment of necrotizing enterocolitis was performed from 1978 through 1983. From 1974 through 1977, 17 patients survived nonoperative treatment of NEC and three developed symptomatic strictures, an incidence of 18% (3/17). Since then a total of 31 infants were treated for NEC; three patients survived operation for perforation and there were seven deaths, leaving 21 in the study group. Sixteen patients had contrast enemas three to six weeks after resolution of NEC, which revealed strictures in five patients. Four of the five patients with strictures demonstrated on contrast enema were without obstructive symptoms. Three of the four remained asymptomatic without treatment, and one eventually required surgery for intestinal obstruction. The fifth patient developed intestinal obstruction while still in the nursery and a contrast study demonstrated an ileal stricture. A sixth patient had a normal contrast study and developed intestinal obstruction from an ileal stricture. The incidence of strictures was 38% (6/16). In five patients, appointments for contrast studies were not kept, although clinical follow-up was complete in all. The incidence of symptomatic strictures for the contrast study period was therefore 14% (3/21). Although some authors have recommended routine contrast enemas in patients surviving nonoperative treatment of NEC, contrast enemas had no advantage over clinical follow-up in the management of patients in this study. We have discontinued the use of routine contrast enemas in favor of close follow-up and careful instruction to parents as to the early signs of intestinal obstruction.
1978年至1983年开展了一项研究，以确定对比灌肠在诊断和处理坏死性小肠结肠炎非手术治疗后肠道狭窄方面的价值。1974年至1977年，17例坏死性小肠结肠炎非手术治疗的患者存活，其中3例出现有症状的狭窄，发生率为18%（3/17）。此后，共有31例婴儿接受坏死性小肠结肠炎治疗；3例穿孔手术患者存活，7例死亡，研究组剩余21例。16例患者在坏死性小肠结肠炎病情缓解后三至六周接受对比灌肠，其中5例显示有狭窄。对比灌肠显示有狭窄的5例患者中，4例无梗阻症状。4例中的3例未经治疗仍无症状，1例最终因肠梗阻需要手术。第5例患者仍在托儿所时出现肠梗阻，对比检查显示回肠狭窄。第6例患者对比检查正常，但因回肠狭窄出现肠梗阻。狭窄发生率为38%（6/16）。5例患者未按预约进行对比检查，不过所有患者均有完整的临床随访。因此，对比检查期间有症状狭窄的发生率为14%（3/21）。尽管一些作者建议对坏死性小肠结肠炎非手术治疗存活的患者进行常规对比灌肠，但在本研究中，对比灌肠在患者管理方面并不比临床随访更具优势。我们已停止使用常规对比灌肠，转而采用密切随访，并就肠梗阻的早期迹象对家长进行仔细指导。
