关键词: font-family:NEU-BZ, "> , ">肠狭窄；">坏死性小肠结肠炎；">新生儿

Abstract:

Objective　To explore the early diagnosis and treatment experience of secondary intestinal stricture in medically treated neonatal necrotizing enterocolitis (NEC) patients. Methods　A total of 105 patients with secondary intestinal stenosis admitted to Guangdong Women and Children Hospital from January 2016 to June 2024 were selected as the study objects.There were 53 boys and 52 girls, gestational aged 32(30, 36) weeks, birth weight 1.77(1.32, 2.25) kg. All children in the acute stage of NEC were given conservative treatments such as fasting, gastrointestinal decompression, and anti-infection for a course of more than one week. After the improvement of clinical signs, milk feeding was initiated at a later date. Abdominal plain films or laboratory tests were reexamined when necessary. Medical records of the children patients were collected, including general conditions (gender, gestational age, birth weight), acute stage conditions of NEC, conditions when intestinal stenosis occurs (age of onset, weight, clinical manifestations, comorbidities), imaging manifestations, treatment conditions (age of operation, surgical methods, prognosis), etc. χ² test was used for statistical analysis. Results　A total of 105 children met the research criteria. The age of onset in the acute phase was 14(4, 28) days; after re-eating, the symptoms of intestinal stenosis occurred 27(13, 36) days after the acute onset. All children were diagnosed with intestinal stenosis at 18(10, 26) days after the onset of intestinal stenosis. 35 children were first diagnosed in our hospital after intestinal stenosis or symptoms occurred during hospitalization, and 70 children were transferred to our hospital after suspected surgical conditions in other hospitals. A total of 100 children underwent enema radiography examination. Five children were not subjected to enema radiography examination due to their severe conditions or the need for emergency laparotomy exploration. Children with intestinal stenosis in the colon ( including multiple stenosis of the colon and small intestine ) were included in the colon group, and children with lesions only in the small intestine were included in the small intestine group. The overall diagnostic sensitivity was 77.00% (77/100). The diagnostic sensitivity of colonic stenosis was higher than that of intestinal stenosis [89.74% (70/78) vs. 31.82% (7/22) ] (P<0.05). 92 children underwent one-stage intestinal resection and intestinal anastomosis, and 13 children underwent staged fistula closure. 103 children were cured, and 2 children gave up treatment due to systemic infection and neurological sequelae after operation. Conclusion　Intestinal stricture after conservative treatment of NEC is a common cause of feeding intolerance in neonates, and surgical treatment is effective. Enema contrast has low sensitivity for the diagnosis of small intestinal stricture, and clinicians should combine medical history, clinical manifestations and enema contrast to promote early diagnosis. Early diagnosis and intervention, shorten the hospitalization time, reduce the pain of children.

Key words:  Intestinal stricture,  Necrotizing enterocolitis,  Neonates