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结核性肠道的完整切除改善了NEC的存活率,而不会影响肠道自主性
Caroline Pardy1, Stefanie Berkes2, Rashmi D'Souza1
1Evelina London Children's Hospital, London, United Kingdom.
Journal of pediatric surgery
|November 13, 2023
概括
在死亡性肠球炎 (NEC) 手术中彻底切除死肠,可以提高存活率. 这种方法不会对新生儿的剩余肠功能或肠道自主性产生负面影响.
科学领域:
- 儿科手术 儿科手术
- 新生儿护理 新生儿护理
- 胃肠病学 胃肠病学
背景情况:
- 死性肠球炎 (NEC) 在新生儿护理中是一个重大挑战,关于最佳外科治疗策略的讨论正在进行中.
- 目前对NEC的手术方法包括彻底切除死肠或在位留下患病的肠道,用静脉口腔保持肠道长度.
研究的目的:
- 为了比较完整的肠切除结果与在位留下死肠的结果,用于NEC的外科治疗.
- 评估操作策略对新生儿NEC的生存和肠道自主性的影响.
主要方法:
- 在2015年5月至2019年期间,针对NEC进行腹腔切除术的新生儿的回顾性审查.
- 数据收集包括人口统计,新生儿序列器官衰竭评估 (nSOFA) 评分,手术发现和执行的手术.
- 新生儿被分为完全切除 (CR) 或留在现场 (LIS) 组,生存和肠道自主性分别是主要和次要结局.
主要成果:
- 在包括的44名新生儿中,27名接受了CR,17名患有LIS. 总体生存率为73% (32/44名新生儿).
- 在单变量 (OR 9.0) 和多变量 (OR 4.87) 分析中,完全切除 (CR) 与改善的生存率显著相关.
- 虽然88%的幸存者实现了肠道自主,但手术方法和肠道自主之间没有显著的关联.
结论:
- 在NEC手术中,全切除死肠与显著更高的生存概率有关.
- 选择的手术策略 (完全切除与留下肠在位) 并没有影响幸存的新生儿实现肠道自主.
- 这项研究支持完全切除作为NEC有益的外科手术方法,提高生存率而不影响长期肠道功能.
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