O'Neill J A, Holcomb G W
Ann Surg. 1979 May;189(5):612-9. doi: 10.1097/00000658-197905000-00011.
Neonatal necrotizing enterocolitis, a highly lethal disorder of premature infants, is a common occurrence in newborn care units. This report details operative experience with 33 infants over the past seven years. During this time many more infants with NNE have recovered with supportive therapy. All patients are treated on a standard protocol of therapy and monitoring designed to select those with signs of continuing clinical deterioration. Therefore, those coming to operation had additional complications, such as perforation, intestinal gangrene or stenosis. This protocol is described. The 33 infants, averaging less than 4 lbs., developed NNE within five days of birth. Perforation and signs of continued clinical deterioration were the indications for operation; severe sepsis and clotting abnormalities were the rule. The overall mortality was 40% but included six infants with total bowel necrosis who had laparotomy alone. Five patients had intestinal or colonic resection with primary anastomosis, with two leaks leading to death. Twenty-one patients had staged resection with delayed anastomosis and only four deaths. Thus 27 determinative cases had a 26% mortality, and the recent group with staged resection had a 19% mortality. The essentials of pre-, intra- and postoperative management are detailed, as well as pathology and bacteriologic data. Most infants had temporary malabsorption requiring parenteral nutrition and special diets. Long-term results are gratifying.
新生儿坏死性小肠结肠炎是一种早产儿的高致死性疾病，在新生儿重症监护病房很常见。本报告详细介绍了过去七年中33例婴儿的手术经验。在此期间，更多患有坏死性小肠结肠炎的婴儿通过支持治疗康复。所有患者均按照标准治疗和监测方案进行治疗，该方案旨在筛选出有持续临床恶化迹象的患者。因此，接受手术的患者存在其他并发症，如穿孔、肠坏疽或狭窄。本文描述了该方案。这33例婴儿平均体重不足4磅，在出生后五天内患上坏死性小肠结肠炎。穿孔和持续临床恶化迹象是手术指征；严重脓毒症和凝血异常很常见。总体死亡率为40%，但其中包括6例仅接受剖腹手术的全肠坏死婴儿。5例患者接受了肠或结肠切除及一期吻合术，2例吻合口漏导致死亡。21例患者接受了分期切除及延迟吻合术，仅4例死亡。因此，27例确诊病例的死亡率为26%，最近一组接受分期切除的患者死亡率为19%。文中详细介绍了术前、术中和术后管理要点，以及病理和细菌学数据。大多数婴儿有暂时性吸收不良，需要肠外营养和特殊饮食。长期结果令人满意。
