| Objective:In order to seek clinical evidence for a reasonable choice of treatment, timing of surgery and surgical approaches, and provide a theoretical basis for positive prevention and early intervention, the occurrence and distribution related therapy and prognosis of neonatal necrotizing enterocolitis (NEC) were analyzed retrospectively for the role of disease-related risk factors in the prognosis and outcomes of NEC.Method:All the patients with NEC were enrolled in the Children Hospital of Fudan University from Jul.2001to Jul.2011. Clinic data were collected including perinatal factors, clinical manifestations after birth, laboratory findings, complications, treatment and prognosis. All the relevant factors with occurrence, development and prognosis in NEC were analyzed by STATA11.0. It was paid close attention to risk factors, treatment measures, timing of surgical intervention and surgical approaches.Results:1、During10years,372patients diagnosed NEC and265cases of them were preterm infants (265/372,71.2%). In all patients,287cases cured well (287/372,77.2%), the total cure rate of77.2%. And230cases were cured by conservative treatment.15cases which occurred intestinal stenosis after conservative treatment, and then cured by operation,42cases which were failed to conservative treatment were cured by enterostomy and colostomy closure.2、According to the diagnostic criterion and guideline of Bell,131cases were classified as in the Phase Ⅰ of Bell with cure rate89.3%;163cases as the Phase Ⅱ, with cure rate82.2%, and78cases as the Phase Ⅲ, with cure rate46.2%.3、In the perinatal factors, low birth weight was confirmed the only risk factor in NEC. While gestational age, asphyxia, Apgar score of one-minute after birth, mode of delivery and maternal age factors were no significant relevance in pathogenesis with NEC.4、By stepwise multiple logistic regression analysis, peritonitis and shock symptoms could significantly enhance the surgical risk of preterm infants with NEC, and the dead risk in postoperative NEC (OR value was in the range of12-27times). Although the white blood cells counts>20×109/L, PH<7.3, platelets counts<100×109/L, and positive blood culture might increase the similar risk either (the OR was between1-3times).5、In76cases of the surgical treatment, the overall cure rate was75%. There were58cases with enterostomy or enterostomy combined with abdominal drainage, and the survival rate was72.4%.16cases of primitive intestinal anastomosis were received by a narrow segment of intestinal resection, and the survival rate93.8%.2cases only were received by the abdominal drainage, but both of them were died.6、In58cases of enterostomy, there were17cases (accouted by29.3%) whose lesions were discovered to be located in the small intestine, but not involving the ileocecal junction,34cases (accouted by58.6%) in the terminal ileum involving the ileocecal and ascending colon,7cases (accouted by12.1%) only in the colon.7、With conservative treatment,230cases were cured well, and16cases had to repuire surgical procedure because of intestinal stenosis after conservative treatment. Incidence of intestinal stenosis when the NEC patients received the conservative treatment was6.5%(16/246). In42cases with cured after enterostomy,11cases occurred to distal bowel stricture after enterostomy. accounting for26.2%(11/42).8、In27cases with intestinal stenosis, there were15cases with a single stenosis, accounting for56.6%, and12cases with multiple narrow (2and above), accounting for44.4%. In terms of the location of of intestinal stenosis,23in the small intestine,11in ascending colon,4in descending colon,4in transverse colon.Conclusion:1、With NICU establishing and becoming more mature, the admitted rate and survival rate of premature children were promoted during last10years., NEC cases were gradually increased in our hospital either. In our result,71.2%preterm infants was diagnosed as NEC, the total cure rate was77.2%during10years.2、Low birth weight was the only risk factors of NEC, although peritonitis, shock, PH<7.3, the PLT<100×109/L, WBC>20×109/L could increase risk of surgery and death in preterm infants some what. 3、The incidence of complication of intestinal stenosis with the non-surgical treatment was6.5%, and the cure rate of operation was higher than90%. The enterostomy was the most common approach in NEC with surgical treatment, and the cure in about70%. The mortality of primitive abdominal drainage was still high, therefore, it was only applied for the patients with extremely low birth weight and extremely critical infants with intolerance operation as a complementary measure.4、The common lesion of NEC were still terminal ileum, ileocecal or ascending colon, but only involving the transverse colon, descending colon were relatively few cases. Intestinal stenosis was a common complication of NEC, the common leision of which were also located in the terminal ileum or ascending colon, and the multiple narrow accounted for more than half of them. |
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