Schimpl G, Höllwarth M E, Fotter R, Becker H
Department of Pediatric Surgery, University of Graz, Medical School, Austria.
Acta Paediatr Suppl. 1994;396:80-3. doi: 10.1111/j.1651-2227.1994.tb13251.x.
Between 1975 and 1992, in 16 infants (14%) out of 113 neonates with previous necrotizing enterocolitis (NEC) a total of 25 intestinal strictures had to be treated. Four (16%) were found in the ileum and 21 (84%) in the colon, and in 50% multiple strictures were present. In these 16 patients initial treatment for acute NEC included conservative treatment in 5, primary resection and enterostomies in 6 and proximal diverting enterostomies in 5. Therefore, the incidence of late strictures was 11% after conservative therapy, 11% after primary resection and 55% after primary proximal diverting enterostomies. An average of 49 days elapses between the recovery from NEC and the diagnosis of late strictures in conservatively treated patients. After initial surgical treatment, late strictures were detected on contrast studies on an average of 80 days. In pathologic specimens, marked fibrosis in the submucosa was consistently present in all strictures, whereas inflammatory changes in the mucosa, disruption or hypertrophy of the muscle layers or absence of ganglion cells were seen less frequently. All strictures were resected and primary end-to-end anastomosis was performed. But despite the development of late intestinal strictures, bowel preservation was improved after initial restrictive surgical therapy and aggressive medical treatment.
1975年至1992年间，在113例曾患坏死性小肠结肠炎（NEC）的新生儿中，有16例（14%）共出现25处肠道狭窄需要治疗。其中4处（16%）位于回肠，21处（84%）位于结肠，50%的患者存在多处狭窄。在这16例患者中，急性NEC的初始治疗包括5例采用保守治疗，6例行一期切除并造口，5例行近端转流造口。因此，保守治疗后晚期狭窄的发生率为11%，一期切除后为11%，一期近端转流造口后为55%。保守治疗的患者从NEC恢复到诊断出晚期狭窄平均间隔49天。初始手术治疗后，造影检查平均在80天后发现晚期狭窄。在病理标本中，所有狭窄处均始终存在黏膜下明显纤维化，而黏膜的炎症改变、肌层破坏或肥厚或神经节细胞缺失则较少见。所有狭窄均行切除并进行一期端端吻合。尽管出现了晚期肠道狭窄，但在初始限制性手术治疗和积极的药物治疗后，肠道保留情况有所改善。
