Kosloske A M, Papile L A, Burstein J
Surgery. 1980 May;87(5):502-8.
A study to evaluate criteria for operation was carried out in 61 infants with acute necrotizing enterocolitis (NEC). A total of 10 clinical, roentgenographic, and laboratory criteria were considered. Each proposed operative criterion was correlated with the documented presence or absence of intestinal gangrene in these infants. Indications for operation verified by this study were (1) pneumoperitoneum, (2) paracentesis findings positive for gangrenous intestine, (3) erythema of the abdominal wall, (4) a fixed abdominal mass, and (5) a persistently dilated loop of intestine on serial abdominal radiographs. The first two signs occurred frequently; the latter three were rare. Operative indications which proved to be invalid in this study were (1) clinical deterioration, (2) persistent abdominal tenderness, (3) profuse lower gastrointestinal hemorrhage, (4) the roentgenographic finding of gasless abdomen with ascites, and (5) severe thrombocytopenia. Twenty-four of the infants were operated on. The mortality rate among the infants operated on after free intestinal perforation had occurred (64%) was double that of infants operated on for intestinal gangrene without perforation (30%). Paracentesis may identify infants with intestinal gangrene prior to the development of perforation and may permit advantagenous timing of operation. This analysis of the frequency and reliability of proposed operative criteria may aid the surgical decision.
一项评估手术标准的研究在61例急性坏死性小肠结肠炎（NEC）婴儿中开展。共考虑了10项临床、影像学和实验室标准。将每项提议的手术标准与这些婴儿中已证实的肠坏疽存在与否相关联。本研究验证的手术指征为：（1）气腹；（2）腹腔穿刺抽出物发现坏疽肠段；（3）腹壁红斑；（4）固定性腹部肿块；（5）系列腹部X线片显示持续扩张的肠袢。前两个体征出现频繁；后三个罕见。本研究中被证明无效的手术指征为：（1）临床恶化；（2）持续性腹部压痛；（3）大量下消化道出血；（4）X线片显示无气腹伴腹水；（5）严重血小板减少症。24例婴儿接受了手术。发生游离性肠穿孔后接受手术的婴儿死亡率（64%）是未发生穿孔的肠坏疽接受手术婴儿死亡率（30%）的两倍。腹腔穿刺可在穿孔发生前识别出患有肠坏疽的婴儿，并可能使手术时机更有利。对提议的手术标准的频率和可靠性进行的这项分析可能有助于手术决策。
