Ladd A P, Rescorla F J, West K W, Scherer L R, Engum S A, Grosfeld J L
Department of Surgery, Indiana University School of Medicine and the James Whitcomb Riley Hospital for Children, Indianapolis 46202-5200, USA.
J Pediatr Surg. 1998 Jul;33(7):967-72. doi: 10.1016/s0022-3468(98)90516-4.
Necrotizing enterocolitis (NEC) is the most common surgical emergency among newborns and is associated with a high morbidity and mortality. This study evaluates the long-term survival of infants requiring surgical intervention for NEC and factors affecting outcome.
A retrospective review of infants requiring surgery for complications of NEC at a tertiary care, pediatric hospital over a 16-year period was performed. Patients were evaluated for early and late morbidity and mortality, length of intestinal resection, presence of the ileocecal valve (ICV), days of parenteral nutrition (PN), and growth.
Two hundred forty-nine patients were included, with an average gestational age of 30 +/- 5 (+/- SD) weeks and birth weight of 1.50 +/- 0.89 kg. The surgical mortality rate was 45%, with survivors (137) being larger (P < .001) and older (P < .001) at time of birth than nonsurvivors. Mortality rates varied inversely with gestational age and birth weight. Surgical survivors had an average of 21 +/- 26 cm of intestinal length resected. The ileocecal valve was preserved in 45% of infants. Growth was similar between infants with or without an ICV. Stratification of length of intestine resected showed that infants with larger resections had greater requirements for parenteral nutrition, but this had no influence on long-term growth at follow-up.
Survivors of NEC are characterized by greater gestational age, greater birth weight, and older postgestational age at surgery. Infants who underwent greater intestinal resections required longer periods of PN. The length of intestine resected or presence of the ileocecal valve had no overall bearing on long-term outcome.
坏死性小肠结肠炎（NEC）是新生儿中最常见的外科急症，且发病率和死亡率都很高。本研究评估了因NEC需要手术干预的婴儿的长期生存情况以及影响预后的因素。
对一家三级护理儿科医院16年间因NEC并发症需要手术的婴儿进行回顾性研究。对患者的早期和晚期发病率、死亡率、肠切除长度、回盲瓣（ICV）的存在情况、肠外营养（PN）天数以及生长情况进行评估。
共纳入249例患者，平均胎龄为30±5（±标准差）周，出生体重为1.50±0.89kg。手术死亡率为45%，存活者（137例）出生时比非存活者体重更大（P<.001）且胎龄更大（P<.001）。死亡率与胎龄和出生体重呈负相关。手术存活者平均切除肠段长度为21±26cm。45%的婴儿保留了回盲瓣。有无ICV的婴儿生长情况相似。对切除肠段长度进行分层分析显示，切除肠段较长的婴儿对肠外营养的需求更大，但这对随访时的长期生长没有影响。
NEC存活者的特点是胎龄更大、出生体重更大以及手术时的孕后年龄更大。接受较大肠段切除的婴儿需要更长时间的PN。切除肠段的长度或回盲瓣的存在对长期预后没有总体影响。
