摘要
目的分析新生儿肠造瘘术后并发症的相关危险因素,为预防并发症和选择治疗措施提供依据。方法回顾性分析2015年1月～2017年6月在我院行新生儿肠造瘘术并获得随访的65例患儿的临床资料,观察其术后并发症的发生,并对其影响因素进行单因素分析和多因素分析。结果 65例患儿中,1例早产儿因新生儿坏死性小肠结肠炎合并重度感染死亡,1例因严重原发疾病以及其它先天性畸形放弃治疗,2例失访。61例获得随访的患儿中发生并发症共30例(49. 18%),其中营养不良15例(50%),造瘘周围皮肤炎症10例(33. 33%),电解质紊乱7例(23. 33%),造瘘肠管脱垂2例(6. 67%),造瘘肠管回缩2例(6. 67%),肠梗阻2例(6. 67%),造瘘大出血1例(3. 33%),切口疝1例(3. 33%)。61例患儿均进行了二期手术关闭造瘘,全部存活。单因素分析显示,患儿术后并发症的发生与出生类型、造瘘位置、造瘘类型和前白蛋白含量相关(P <0. 05),而与性别、是否独生、父母居住地和C反应蛋白含量无关(P> 0. 05)。Logistic回归分析显示,早产、小肠造瘘和前白蛋白含量异常是新生儿肠造瘘术后并发症的独立危险因素(P <0. 05)。结论新生儿肠造瘘术后并发症发生率较高,对患儿的临床康复造成极大的威胁;临床上应高度重视,针对其相关危险因素采取有效干预措施以减少并发症发生。
Objective To analyze the risk factors of complications after neonatal enterostomy and to provide guidelines for prevention of complications and selection of treatment measures. Methods A retrospectively analysis of 65 neonates performed neonatal enterostomy in our hospital from January 2015 to June 2017 was made to summarize the poster-operative complications as well as the associated risk factors. The univariate analysis and multiple logistic regression analysis were applied. Results Among 65 cases,1 premature infant died of neonatal necrotizing enterocolitis combined with severe infection,1 neonate gave up the treatment due to severe primary diseases and other congenital malformations,and 2 neonates were lost to follow-up. 30 cases( 49. 18%)were found poster-operative complications in 61 followed-up cases,including malnutrition in 15 cases( 50%),skin inflammation around the stoma in 10 cases( 33. 33%),electrolyte disturbance in 7 cases( 23. 33%),the fistula prolapse in 2 cases( 6. 67%),the fistula retraction in 2 cases( 6. 67%),intestinal obstruction in 2 cases( 6. 67%),massive hemorrhage in 1 case( 3. 33%) and incision hernia in 1 case( 3. 33%). All 61 cases were carried out the secondary fistulostomy and survived. Univariate analysis showed that the postoperative complications of neonatal enterostomy was correlated with the type of birth,the location of fistula,the type of fistula and the normal content of prealbumin( P < 0. 05),but not correlated with the gender,the only child,the residence of parents and the content of C-reactive protein( P < 0. 05). Logistic regression analysis showed that preterm birth,small intestinal fistula and abnormal prealbumin content were the independent risk factors for complications after neonatal enterostomy( P < 0. 05). Conclusions The complications incidence is relatively high after neonatal enterostomy,and which is a great threat to newborn’s recovery. Effective interventions should be taken to prevent or reduce the occurrence of complications in view of the associated risk factors.
作者
白剑
梁劲文
李秋菊
王少梅
梁裕柱
吴敏秋
BAI Jian;LIANG Jin-wen;LI Qiu-ju;WANG Shao-mei;LIANG Yu-zhu;WU Min-qiu(Department of Pediatric Surgery,Nanhai Maternity & Child Healthcare Hospital of Foshan,Foshan 528200,Guangdong,China)
出处
《中国现代手术学杂志》
2018年第6期419-423,共5页
Chinese Journal of Modern Operative Surgery
关键词
肠造瘘术
术后并发症
新生儿
enterostomy
postoperative complications
newborns
