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

摘要：

目的　探讨新生儿坏死性小肠结肠炎（NEC）保守治疗后继发肠狭窄的早期诊断及治疗经验。方法　选取2016年1月至2024年6月广东省妇幼保健院收治的105例NEC继发肠狭窄患儿作为研究对象。男53例，女52例；胎龄32（30，36）周；出生体重1.77（1.32，2.25）kg。NEC急性期患儿均给予禁食、胃肠减压、抗感染等保守治疗，疗程1周以上，待临床体征改善后择期开奶喂养，必要时复查腹平片或实验室检查。收集患儿病历资料，包括一般情况（性别、胎龄、出生体重）、NEC急性期情况、出现肠狭窄时的情况（发病日龄、体重、临床表现、合并疾病）、影像表现、治疗情况（手术日龄、手术方式、预后）等。采用χ²检验进行统计学分析。结果　共有105例患儿符合研究标准。急性期发病日龄为14（4，28）d；重新进食后，距急性发病时间27（13，36）d出现肠狭窄症状；所有患儿于出现肠狭窄症状后18（10，26）d确诊肠狭窄。35例患儿于本院住院期间出现肠狭窄症状或出现症状后首诊于本院，70例患儿为外院怀疑有外科情况后转至本院。共100例患儿行灌肠造影检查，5例患儿因病情较重或需急诊剖腹探查而未行术前造影。将肠狭窄发生在结肠（包括结肠、小肠多发狭窄）的患儿纳入结肠组，仅小肠存在病灶的患儿纳入小肠组。总体诊断灵敏度为77.00%（77/100），结肠狭窄的诊断灵敏度高于小肠狭窄［89.74%（70/78）比31.82%（7/22）］（P<0.05）。92例患儿行一期肠切除肠吻合，13例患儿行分期造瘘关瘘术。103例患儿治愈，2例患儿术后因全身感染、神经系统后遗症，放弃治疗。结论　NEC保守治疗后肠狭窄是新生儿常见喂养不耐受原因，外科治疗效果确切。灌肠造影诊断小肠狭窄的灵敏度较低，临床医生应结合病史、临床表现和灌肠造影进行综合判断，早期确诊干预，缩短住院时间，减轻患儿痛苦。

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