DeSa D J
Perspect Pediatr Pathol. 1976;3:273-309.
In this review the author's opinion regarding the etiology of most cases of perinatal and neonatal bowel ischemia has been stated. It is recognized that the changes brough about by hypoxia (splanchnic shutdown, bowel ischemia) represent the "soil" on which other "seeds" can prosper. In its simplest form following acute ischemia, the processes of repair take over, leading to functional recovery and a presumably normal bowel. In those patients with more extensive initial damage, degrees of stenosis and even atresia may be expected as a result of the healing of the bowel. Rapidly evolving ischemia may produce perforations; these may be restricted and involve only very small areas of bowel or may be part of a more generalized involvement, possibly even with multiple perforations. In other infants, alterations of bacterial flora could contribute to the clinical picture of "necrotizing enterocolitis," and gas may or may not be present in the bowel wall. If the process of ischemia has been relatively mild, or bacterial overgrowth not particularly marked, some of the more obscure functional syndromes may be noted. The persistence of these obscure syndromes may in turn be related to incomplete phases of regeneration of the bowel that fall short of producing stenosis but lead to a mucosa that is not optimally functional.
在这篇综述中，作者阐述了其对于围产期和新生儿肠道缺血大多数病例病因的观点。人们认识到，缺氧所带来的变化（内脏关闭、肠道缺血）代表了其他“种子”能够繁荣生长的“土壤”。在急性缺血后的最简单形式中，修复过程开始，导致功能恢复以及肠道大概恢复正常。在那些初始损伤更广泛的患者中，由于肠道愈合，可能会出现不同程度的狭窄甚至闭锁。快速进展的缺血可能导致穿孔；这些穿孔可能局限于仅涉及非常小面积的肠道，或者可能是更广泛累及的一部分，甚至可能有多个穿孔。在其他婴儿中，细菌菌群的改变可能导致“坏死性小肠结肠炎”的临床表现，并且肠壁中可能存在或不存在气体。如果缺血过程相对较轻，或者细菌过度生长不是特别明显，可能会出现一些较隐匿的功能综合征。这些隐匿综合征的持续存在反过来可能与肠道再生的不完全阶段有关，这些阶段虽未导致狭窄，但导致黏膜功能未达到最佳状态。
