Lamireau T, Llanas B, Chateil J F, Sarlangue J, Cavert-Jouanolou M H, Vergnes P, Galperine R I, Demarquez J L
Service de réanimation infantile, hôpital Pellegrin-Enfants, Bordeaux, France.
Arch Pediatr. 1996 Jan;3(1):9-15. doi: 10.1016/s0929-693x(96)80002-9.
Stenosis after necrotizing enterocolitis (NEC) has increased from 15 to 57% over the last 10 years in our unit. The aim of this study is to point out the difficulty of diagnosis and treatment, and search for factors explaining this increase.
From 1986 to 1991, 42 newborns had NEC, followed by intestinal strictures in 19 of them (57% of the 33 survivors). Data from these 19 patients were compared with those of the 14 without intestinal strictures. The 33 survivors were also compared with those of an earlier study including 25 NEC seen from 1979 to 1986.
After medical treatment (n = 12), intestinal stenosis led to occlusion after three weeks, was located to both small and large intestine and was short and tight. After surgical treatment (n = 7), stenosis was shown by opacification before digestive anastomosis (n = 5) or revealed by occlusion (n = 2); it stayed on the colon, was long or multiple, requiring extensive resections. No difference could be found between data from patients with or without stenosis. Although newborns were actually more premature, the risk of stenosis was more frequent when newborns of same gestational ages and/or weights were compared.
Intestinal stenosis is a frequent complication after NEC; its diagnosis is often difficult and requires extensive digestive resections. No clinical or therapeutic factor could be found to explain the actual increase in frequency.
在我们科室，坏死性小肠结肠炎（NEC）后的狭窄发生率在过去10年中从15%上升至57%。本研究旨在指出诊断和治疗的困难，并寻找能解释这一上升趋势的因素。
1986年至1991年期间，42例新生儿患NEC，其中19例（33例幸存者中的57%）随后出现肠道狭窄。将这19例患者的数据与14例未出现肠道狭窄患者的数据进行比较。还将这33例幸存者与一项早期研究（1979年至1986年期间观察的25例NEC患者）的患者进行比较。
经内科治疗（n = 12）后，肠道狭窄在三周后导致梗阻，狭窄部位累及小肠和大肠，且狭窄段短而紧。经外科治疗（n = 7）后，狭窄在消化道吻合术前通过造影显示（n = 5）或通过梗阻发现（n = 2）；狭窄位于结肠，呈长段或多发，需要广泛切除。有狭窄和无狭窄患者的数据之间未发现差异。尽管新生儿实际上早产情况更严重，但在比较相同孕周和/或体重的新生儿时，狭窄风险更常见。
肠道狭窄是NEC后的常见并发症；其诊断通常困难，且需要广泛的消化道切除。未发现能解释实际发生率上升的临床或治疗因素。
