本文選題：腸內(nèi)置管外引流術(shù) + 新生兒　； 參考：《東南大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2017年04期

【摘要】：目的:通過評(píng)價(jià)腸內(nèi)置管外引流術(shù)治療新生兒壞死性小腸結(jié)腸炎的臨床療效,探討其臨床應(yīng)用前景。方法:選用2012年8月至2015年8月本院小兒外科重癥監(jiān)護(hù)室收治的由于腸道存在廣泛病變而無法立即確認(rèn)手術(shù)切除范圍的80例壞死性小腸結(jié)腸炎新生兒作為研究對(duì)象,隨機(jī)分為常規(guī)手術(shù)組和腸內(nèi)置管外引流術(shù)組,各40例。常規(guī)手術(shù)組行常規(guī)手術(shù)治療,腸內(nèi)置管外引流術(shù)組采用腸內(nèi)置管外引流術(shù)結(jié)合常規(guī)手術(shù)治療。比較這兩種手術(shù)方式治愈率的差異,術(shù)后6個(gè)月對(duì)痊愈的患兒進(jìn)行定向回訪,調(diào)查患兒術(shù)后體質(zhì)量的改變情況、并發(fā)癥的發(fā)生情況及預(yù)后情況。結(jié)果:腸內(nèi)置管外引流術(shù)組患兒的治愈率為67.5%,明顯高于常規(guī)手術(shù)組的47.5%(χ~2=3.274,P=0.070);腸內(nèi)置管外引流術(shù)組患兒的手術(shù)時(shí)間為(55.78±10.94)min,顯著低于常規(guī)手術(shù)組的(80.28±11.62)min(t=9.711,P=0.000);術(shù)后回訪結(jié)果顯示,常規(guī)手術(shù)組的患兒體質(zhì)量為(5.89±0.94)kg,明顯低于腸內(nèi)置管外引流術(shù)組的(6.28±0.61)kg(t=2.176,P=0.033);術(shù)后常規(guī)手術(shù)組患兒排便異常發(fā)生率為68.4%,明顯高于腸內(nèi)置管外引流術(shù)組的37%(χ~2=4.394,P=0.036);術(shù)后常規(guī)手術(shù)組患兒不完全腸梗阻發(fā)生率為57.9%,明顯高于腸內(nèi)置管外引流術(shù)組的25.9%(χ~2=4.785,P=0.029)。手術(shù)后大于3處的腸穿孔以及循環(huán)的衰竭是影響治療效果及預(yù)后的主要因素。結(jié)論:腸內(nèi)置管外引流術(shù)治療新生兒壞死性小腸結(jié)腸炎能夠縮短手術(shù)時(shí)間,提高該病的手術(shù)治愈率,有效減少術(shù)后并發(fā)癥的發(fā)生,值得在臨床進(jìn)一步推廣。
[Abstract]:Objective: to evaluate the clinical effect of enteral catheterization and extracorporeal drainage for neonatal necrotizing enterocolitis. Methods: from August 2012 to August 2015, 80 neonates with necrotizing enterocolitis who were admitted to intensive care unit of pediatric surgery in our hospital were selected. They were randomly divided into routine operation group and enteral catheterization external drainage group with 40 cases each. Routine surgical treatment was performed in the routine operation group, and intestinal catheterization and external drainage combined with conventional surgical treatment in the intestinal catheterization group. The difference of the cure rate between the two methods was compared. The patients who were cured 6 months after the operation were interviewed by a targeted visit to investigate the changes of body mass, the occurrence of complications and the prognosis of the patients. Results: the cure rate of the children in the group of internal and external catheterization was 67.5, which was significantly higher than that in the group of routine operation (蠂 2 / 23.274) and the operative time was 55.78 鹵10.94 / min, which was significantly lower than that in the group of routine operation (80.28 鹵11.62min / 9.711P ~ (0.000), and the results of the postoperative follow-up showed that the operative time of the group was 55.78 鹵10.94 / min, which was significantly lower than that of the group of routine operation (80.28 鹵11.62min-1 / min). The body mass of the children in the routine operation group was 5.89 鹵0.94kg, which was significantly lower than that in the external drainage group (6.28 鹵0.61kg / kg), and the incidence of abnormal defecation was 68.4% in the routine operation group, which was significantly higher than that in the external drainage group (蠂 ~ 2 / 24.394) (蠂 ~ 2 / 24.394P ~ (0.036), and in the routine operation group (P < 0.036), the incidence of defecation abnormality in the routine operation group was 68.4%, which was significantly higher than that in the external drainage group (P < 0.05). The incidence of incomplete intestinal obstruction was 57.9%, which was significantly higher than that of 25.9% in the external drainage group. Intestinal perforation and circulatory failure more than 3 sites after operation are the main factors affecting the treatment effect and prognosis. Conclusion: the treatment of neonatal necrotizing enterocolitis with internal and external catheter drainage can shorten the operation time, improve the cure rate of the disease, and effectively reduce the incidence of postoperative complications, which is worthy of further promotion in clinical practice.
【作者單位】： 鄭州兒童醫(yī)院;
【基金】：河南省2013年基礎(chǔ)與前沿技術(shù)研究計(jì)劃項(xiàng)目(132300410251)
【分類號(hào)】：R722.1
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本文編號(hào)：2049407