新生儿坏死性小肠结肠炎合并先天性巨结肠23例临床分析

doi:10.3969/j.issn.1671-7171.2018.07.022

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Abstract 【Objective】To investigate the clinical features of patients with neonatal necrotizing enterocolitis (NEC) complicated with Hirschsprung's disease (HD). 【Methods】The clinical data of 289 children with NEC who were admitted to Zhongshan Bo'ai Hospital affiliated to Southern Medical University from January 2010 to December 2017 were retrospectively analyzed. Among them, there were 23 cases of NEC combined with HD. The gestational age, birth weight, feeding style, gender, age of onset, clinical manifestations, laboratory findings, and abdominal X-ray findings of children with NEC combined with HD were collected.【Results】A total of 23 NEC patients with HD accounted for 7.95% (23/289) , of the patients, including 17 males and 6 females, with a mean gestational age of 35.6± 3.7 weeks. Patients enrolled in this study ( n =23) were 14 predominantly term infants (60.9%, 14/23) and 9 premature infants. None of the 23 patients had history of asphyxia/hypoxia or delayed meconium excretion. There were 2 patients of Bell stageⅠ, 4 patients of Bell stage Ⅱ and 14 patients of Bell stage Ⅲ, respectively. There were 11 patients with fever and 2 patients with low temperature.All 23 patients had abdominal distention, of whom 21 patients had history of vomiting and 11 patients had gastrointestinal hemorrhage, accounting for 91.3% and 47.8% respectively. There were 9 cases (39.1%) with swollen redness of abdominal wall, 13 cases (56.3%) with abdominal wall tenderness and 11 cases (47.8%) with peristaltic sound disappearance. One patient was found with gas feces ejection during rectum examination. In 23 patients, there were 8 cases (34.8%) with pneumoperitoneum, 6 cases (26.1%)with intestinal wall pneumatosis, 18 cases (78.3%) with intestinal stiffness, 16 cases (69.6%) with intestinal wall thickening, 2 cases(8.7%) with colon dilatation, 16 cases(69.6%) with intestinal obstruction, and 4 cases (17.4%) with hepatic portal venous gas. Treatment and prognosis: Symptoms of 6 patients of Bell stage Ⅰ and stage Ⅱ patients were improved after conservative treatment; 17 children of Bell stage Ⅲ received surgery. In total, 21 cases were cured, 1 case quitted treatment, and 1 case died. 【Conclusion】It is not uncommon for children with NEC to have HD. The presentations and imaging manifestations are not specific. Rectal biopsy is an important means of diagnosis. Early diagnosis is useful for surgical options and prognosis.

Key words： Enterocolitis, Necrotizing/CO Hirschsprung Disease/CO Infant, Newborn;

Received: 26 April 2018

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R725.745

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http://www.jcr.net.cn/EN/10.3969/j.issn.1671-7171.2018.07.022 OR http://www.jcr.net.cn/EN/Y2018/V35/I7/1314

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