Schwartz M Z, Richardson C J, Hayden C K, Swischuk L E, Tyson K R
J Pediatr Surg. 1980 Dec;15(6):890-9. doi: 10.1016/s0022-3468(80)80300-9.
In the past decade, increased clinical awareness and better medical and surgical management of necrotizing enterocolitis (NEC) has resulted in improved survival. With an increase in the number of infants surviving the acute stages of NEC the sequelae, including intestinal stenosis, have become more apparent. In the past 5.5 yr, 62 patients with NEC have been treated at our institution. Of the 28 survivors of medical management for NEC seven patients developed intestinal stenosis. An average of 23 days elapsed between the recovery from NEC and the diagnosis of colonic stenosis. Only three patients manifested symptoms of intestinal obstruction. Two patients had blood in their stools and two patients were asymptomatic. Five infants were managed by primary or staged resection of the intestinal stenosis. The remaining two patients were treated nonoperatively. Our data suggests a high incidence of intestinal stenosis (25%) following medical management of NEC. There is a marked preference for the stenosis to occur on the left side of the colon. Colon stenoses can exist without symptoms and radiographically proven areas of stenosis can resolve. We recommend that all infants following medical management of NEC have a barium enema prior to hospital discharge. In selected cases asymptomatic patients with colonic stenosis may not require operative intervention.
在过去十年中，临床意识的提高以及对坏死性小肠结肠炎（NEC）更好的内科和外科治疗使存活率得到了提高。随着NEC急性期存活婴儿数量的增加，包括肠道狭窄在内的后遗症变得更加明显。在过去5.5年里，我们机构共治疗了62例NEC患者。在接受内科治疗的28例NEC存活者中，有7例发生了肠道狭窄。从NEC恢复到结肠狭窄诊断之间平均间隔23天。只有3例患者出现肠梗阻症状。2例患者大便带血，2例患者无症状。5例婴儿接受了肠道狭窄的一期或分期切除治疗。其余2例患者接受了非手术治疗。我们的数据表明，NEC内科治疗后肠道狭窄的发生率很高（25%）。狭窄明显更倾向于发生在结肠左侧。结肠狭窄可能没有症状，经影像学证实的狭窄区域也可能会自行缓解。我们建议所有接受NEC内科治疗的婴儿在出院前进行钡灌肠检查。在某些情况下，无症状的结肠狭窄患者可能不需要手术干预。
