切换至 "中华医学电子期刊资源库"

中华临床医师杂志(电子版) ›› 2025, Vol. 19 ›› Issue (09) : 659 -667. doi: 10.3877/cma.j.issn.1674-0785.2025.09.004

临床研究

新生儿期行肠造瘘术患儿临床特征及术后并发症危险因素
刘晔1, 崔丽茹1, 刘田田1, 魏山坡2, 张晓辉2, 姜敏1,()   
  1. 1 071000 河北保定,首都医科大学附属北京儿童医院保定医院新生儿科
    2 071000 河北保定,首都医科大学附属北京儿童医院保定医院新生儿外科
  • 收稿日期:2025-08-27 出版日期:2025-09-30
  • 通信作者: 姜敏

Clinical characteristics and risk factors for postoperative complications in neonates undergoing enterostomy surgery

Ye Liu1, Liru Cui1, Tiantian Liu1, Shanpo Wei2, Xiaohui Zhang2, Min Jiang1,()   

  1. 1 Department of Neonatology, Baoding Hospital, Beijing Children's Hospital, Capital Medical University, Baoding 071000, China
    2 Department of Neonatal Surgery, Baoding Hospital, Beijing Children's Hospital, Capital Medical University, Baoding 071000, China
  • Received:2025-08-27 Published:2025-09-30
  • Corresponding author: Min Jiang
引用本文:

刘晔, 崔丽茹, 刘田田, 魏山坡, 张晓辉, 姜敏. 新生儿期行肠造瘘术患儿临床特征及术后并发症危险因素[J/OL]. 中华临床医师杂志(电子版), 2025, 19(09): 659-667.

Ye Liu, Liru Cui, Tiantian Liu, Shanpo Wei, Xiaohui Zhang, Min Jiang. Clinical characteristics and risk factors for postoperative complications in neonates undergoing enterostomy surgery[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2025, 19(09): 659-667.

目的

分析行肠造瘘术新生儿的临床疾病类型,临床特点及预后,以及影响造瘘患儿术后并发症的危险因素。

方法

回顾性分析首都医科大学附属北京儿童医院保定医院2013年1月至2023年8月收治的肠造瘘术新生儿资料,按原发病分为NEC组与非NEC组,分析各组患儿临床资料的差异,总结NEC及非NEC组肠造瘘患儿临床特征;根据NEC患儿术后有无并发症分组分析,采用多因素Logistic回归模型分析危险因素。

结果

共纳入80例患儿,其中原发病为NEC组37例(46.3%),非NEC组43例(53.7%)。NEC组患儿胎龄、出生体重小于非NEC组,低出生体重儿比例更高(均P<0.05)。起病症状(发生发热、腹胀、便血、呼吸暂停的例数)、低钠血症例数、实验室检查(CRP数值)、术后临床特点及并发症(如全肠道喂养时间、高流量腹泻、合并ROP发生率)方面,NEC组均高于非NEC组,差异有统计学意义(P<0.05);炎症指数(SII)上NEC组SII值小于非NEC组(P<0.05)。NEC组内,有并发症组起病日龄晚,呼吸衰竭发生率高于无并发症组,差异有统计学意义(均P<0.05),且多因素Logistic回归分析表明呼吸衰竭是NEC患儿肠造瘘术后并发症的危险因素。

结论

NEC肠造瘘患儿胎龄小、体重低,发病晚、临床表现重,术后并发症发生率高、预后差,呼吸衰竭是其术后并发症的危险因素。

Objective

To analyze the clinical disease types, clinical characteristics, and prognosis of neonates undergoing enterostomy, as well as the risk factors for postoperative complications.

Methods

A retrospective analysis was conducted on the data of neonates who underwent enterostomy in Baoding Hospital Affiliated to Capital Medical University from January 2013 to August 2023. These neonates were divided into an NEC (necrotizing enterocolitis) group and a non-NEC group according to the primary disease. The differences in clinical data between the groups were analyzed, and the clinical characteristics of neonates with enterostomy in the two groups were summarized. Based on whether postoperative complications occurred in NEC neonates, they were further grouped for analysis. Multivariate logistic regression models were employed to analyze the risk factors for postoperative complications.

Results

A total of 80 neonates were included in this study. Among them, 37 cases (46.3%) were in the NEC group with the primary disease being NEC, and 43 cases (53.7%) were in the non-NEC group. The gestational age and birth weight of neonates in the NEC group were lower than those of the non-NEC group, and the proportion of low-birth-weight neonates was higher (all P<0.05). The number of neonates with onset symptoms (fever, abdominal distension, hematochezia, and apnea), the number of neonates with hyponatremia, laboratory test results (e.g., C-reactive protein), postoperative clinical characteristics and complications (such as the time to achieve full enteral feeding, the incidence of high-flow diarrhea, and the incidence of combined tetinopathy of prematurity) were all significantly higher in the NEC group than in the non-NEC group (P<0.05). The systemic immune-inflammation index (SII) in the NEC group was lower than that of the non-NEC group (P<0.05). Within the NEC group, the onset age of neonates with complications was significantly later, and the incidence of respiratory failure was significantly higher than that of neonates without complications (both P<0.05). Multivariate logistic regression analysis demonstrated that respiratory failure was a risk factor for postoperative complications in NEC neonates after enterostomy.

Conclusion

Neonates with NEC undergoing enterostomy have a younger gestational age, lower weight, later onset of age, more severe clinical manifestations, a higher incidence of postoperative complications, and a poorer prognosis. Respiratory failure is a significant risk factor for postoperative complications in NEC neonates undergoing enterostomy.

表1 新生儿肠造瘘术患儿原发疾病(n=80)[例(%)]
表2 非NEC组主要疾病亚型临床特征分布(n=43)
图1 Z评分生长曲线
表3 NEC组与非NEC组肠造瘘患儿围生期特点比较
表4 NEC组与非NEC组肠造瘘患儿手术前临床特征
项目 NEC组(n=37) 非NEC组(n=43) χ2/Z值 P
发病日龄(d) 14.00(7.00,24.00) 1.12(0.48,5.01) -5.322 <0.001
起病症状[例(%)]
发热或体温不升 7(18.92) 0(0.00) 6.70 0.003
腹胀 32(86.49) 12(27.91) 25.26 <0.001
便血 23(62.16) 5(11.63) 20.16 <0.001
呕吐 5(13.51) 14(32.56) 3.00 0.083
呼吸暂停 11(29.73) 0(0.00) 5.157 <0.001
实验室检指标
CRP[mg/L,MQ1Q3)] 68.72(12.67,104.68) 5.30(0.50,20.13) -5.134 <0.001
血小板[×109/L,MQ1Q3)] 249.00(157.00,309.00) 243.00(172.50,283.00) -0.019 0.985
中性粒计数[×109/L,MQ1Q3)] 4.99(2.61,8.69) 17.12(13.64,21.79) 5.853 <0.001
淋巴细胞计数(l)[×109/L,MQ1Q3)] 1.14(0.78,1.95) 2.30(2.00,3.17) 4.125 <0.001
单核细胞计数(m)[×109/L,MQ1Q3)] 1.10(0.35,2.31) 1.44(1.08,1.87) 1.491 0.136
SII 492.75(171.90,966.39) 1086.45(615.57,1677.08) 3.064 0.002
低钠血症[例(%)] 16(43.24) 8(18.60) 4.64 0.031
确定手术时机的主要指标[例(%)]
腹膜炎症状 31(83.78) 3(6.98) 44.92 <0.001
影像学表现进展 34(91.89) 4(9.30) 51.14 <0.001
腹腔游离气体 22(59.46) 1(2.33) 28.96 <0.001
穿刺液异常 19(51.35) 1(2.33) 22.95 <0.001
出现症状至手术的时间[h,MQ1Q3)] 36.00(24.00,59.00) 24.00(24.00,63.50) -0.396 0.688
临床结局[例(%)]
好转 27(72.97) 43(100.00) 10.93 <0.001
表5 NEC组与非NEC组肠造瘘患儿术后临床特点及并发症比较
表6 影响NEC有并发症组和无并发症组患儿结局的单因素分析
图2 多因素Logistic回归分析森林图
表7 多因素Logistic回归分析
1
Pijpers AGH, Imren C, van Varsseveld OC, et al. Short-term postoperative complications in preterm neonates with surgical necrotizing enterocolitis: a multicenter retrospective cohort study [J]. Pediatr Surg Int, 2024, 41(1): 38-38.
2
Ribeiro JV, Salamonde JDF, Perin JPS, et al. Optimal closure timing for protective jejunostomy in an infant with necrotizing enterocolitis: A case report [J]. Am J Case Rep, 2025, 26: e947801.
3
Andrews RE, Coe KL. Clinical presentation and multifactorial pathogenesis of necrotizing enterocolitis in the preterm infant [J]. Adv Neonatal Care, 2021, 21(5): 349-355.
4
邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学 [M]. 5版. 北京: 人民卫生出版社, 2019.
5
Ezomike UO, Nwachukwu IE, Nwangwu EI, et al. Childhood colostomies: patterns, indications and outcomes in a Nigerian University Teaching Hospital [J]. Afr Health Sci, 2022, 22(4): 205-211.
6
彭艳芬, 何秋明, 郑海清, 等. 新生儿小肠造瘘术后营养状态及危险因素分析 [J]. 中华新生儿科杂志, 2018, 33(5): 350-353.
7
中华医学会小儿外科学分会新生儿学组. 新生儿坏死性小肠结肠炎小肠造瘘术后临床治疗专家共识 [J]. 中华小儿外科杂志, 2016, 37(8): 563-567.
8
De Vore GR, Epstein A. Computing Z-score equations for clinical use to measure fetal umbilical vein size and flow using six independent variables of age and size [J]. J Ultrasound Med, 2022, 41(8): 1949-1960.
9
Wang L, Zhou Q, Zhou C, et al. Z-score reference ranges for umbilical vein diameter and blood flow volume in normal fetuses [J]. J Ultrasound Med, 2022, 41(4): 907-916.
10
Chen L, Kong X, Wang Z, et al. Pre-treatment systemic immune-inflammation index is a useful prognostic indicator in patients with breast cancer undergoing neoadjuvant chemotherapy [J]. J Cell Mol Med, 2020, 24(5): 2993-3021.
11
Terrin G, Scipione A, De Curtis M. Update in pathogenesis and prospective in treatment of necrotizing enterocolitis [J]. Biomed Res Int, 2014, 2014: 543765.
12
李军, 李松. 新生儿坏死性小肠结肠炎危险因素分析 [J]. 中国实用医药, 2010, 5(14): 24-26.
13
余珍珠, 黄惠君, 刘晓红, 等. 新生儿坏死性小肠结肠炎80例临床分析 [J]. 中华围产医学杂志, 2014, 17(1): 55-57.
14
Bokova E, Svetanoff WJ, Lopez JJ, et al. State of the art bowel management for pediatric colorectal problems: anorectal malformations [J]. Children (Basel, Switzerland), 2023, 10(5): 846.
15
Yang X, Wang W, Wang K, et al. Identification and treatment of intestinal malrotation with midgut volvulus in childhood: a multicenter retrospective study [J]. Frontiers in Pediatrics, 2024, 12: 1390856.
16
Rentea MR, Bokova E, Frischer SJ, et al. Evaluation and management of total colonic hirschsprung disease: A comprehensive review from the American pediatric surgical association (APSA) hirschsprung disease interest group [J]. J Pediatr Surgy, 2024, 59(11): 161677.
17
Nicoară DM, Munteanu AI, Scutca AC, et al. Examining the relationship between systemic immune-inflammation index and disease severity in juvenile idiopathic arthritis [J]. Cells, 2024, 13(5): 442.
18
黄艳, 梁小琴, 张敏, 等. 新生儿坏死性小肠结肠炎不良预后危险因素分析 [J]. 中华新生儿科杂志(中英文), 2018, 33(5): 368-371.
19
陈瑛, 张迪, 王晓颖, 等. 血小板参数与极低出生体重儿严重并发症和住院时长的相关性 [J/OL]. 中华临床医师杂志(电子版), 2021, 15(2): 87-94.
20
Yu M, Liu G, Feng Z, et al. Combination of plasma white blood cell count, platelet count and C-reactive protein level for identifying surgical necrotizing enterocolitis in preterm infants without pneumoperitoneum [J]. Pediatr Surg Int, 2018, 34(9): 945-950.
21
Kangel D, Ozyılmaz İ, Ozkok S, et al. New systemic inflammatory indices as predictors of fulminant myocarditis in children [J]. Diagnostics (Basel, Switzerland), 2025, 15(8): 961-961.
22
He Y, Cao L, Yu J. Prophylactic lactoferrin for preventing lateonset sepsis and necrotizing enterocolitis in preterm infants: a PRISMA- compliant systematic review and meta- analysis [J]. Medicine (Baltimore), 2018, 97(35): e11976.
23
Sjoberg BT, Ahle M, Elfvin A, et al. Intestinal failure after necrotising enterocolitis: incidence and risk factors in a Swedish population- based longitudinal study [J]. BMJ Paediatr Open, 2018, 2(1): e000316.
24
Masoli D, Dominguez A, Tapia JL, et al. Enteral feeding and necrotizing enterocolitis: Does time of first feeds and rate of advancement matter? [J]. J Pediatr Gastroenterol Nutr, 2021, 72(5): 763-768.
25
Barron LK, Warner BB, Tarr PI, et al. Independence of gut bacterial content and neonatal necrotizing enterocolitis severity [J]. J Pediatr Surg, 2017, 52(6): 993-998.
26
Han G, Lim DH, Kang D, et al. Association between retinopathy of prematurity in very-low-birth-weight infants and neurodevelopmental impairment [J]. Am J Ophthalmol, 2022, 244: 205-215.
27
Lissner GS, Romano PE. Pneumatosis oculi and spontaneous hyphema in association with pneumatosis intestinalis [J]. Am J Ophthalmol, 1979, 88(4):708-713.
28
Golubkova A, Hunter CJ. Updates and recommendations on the surgical management of NEC [J]. Semin Perinatol, 2023, 47(1): 151698.
29
Wynn JL, Wong HR. Pathophysiology and treatment of septic shock in Neonates [J]. Clin Perinatol, 2010, 37(2):439-479.
30
Anand RJ, Leaphart CL, Mollen KP, et al. The role of the intestinal barrier in the pathogenesis of necrotizing enterocolitis [J]. Shock, 2007, 27(2): 124-133.
31
Jones IH, Hall NJ. Contemporary outcomes for infants with necrotizing enterocolitis-a systematic review [J]. J Pediatr, 2020, 220: 86-92.e3.
[1] 黄卓, 乔玮玮, 王莉. 根管治疗中器械分离的预后评估与处理决策[J/OL]. 中华口腔医学研究杂志(电子版), 2025, 19(06): 360-368.
[2] 杨一辰, 廖习成, 马玥麟, 李迎, 王祥柱. 基于旁路的复杂器械分离经根管取出策略探索与疗效评价[J/OL]. 中华口腔医学研究杂志(电子版), 2025, 19(06): 369-377.
[3] 王毅, 孔剑桥, 张鹏, 代扬, 李恒平. 腹腔镜超声引导十二指肠镜治疗胆囊合并胆总管结石[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(06): 658-661.
[4] 马超, 王传嘉, 张武坊. 经腋窝入路单孔腔镜保乳术与传统开放手术治疗早期乳腺癌的对比研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(06): 674-677.
[5] 张超, 常剑. 混合入路与中间入路行腹腔镜右半结肠癌根治术的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(06): 685-688.
[6] 陈系东, 王绍闯, 赵何伟, 王硕, 袁维栋. 高龄BCLC B期肝癌患者常规TACE术后急性肝功能恶化的危险因素研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(06): 689-692.
[7] 钱龙, 蔡大明, 王行舟, 艾世超, 胡琼源, 孙锋, 宋鹏, 王峰, 王萌, 陆晓峰, 朱欢欢, 沈晓菲, 管文贤. 局部不可切除胃癌转化治疗(联合免疫治疗)后淋巴结转移的相关危险因素分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(06): 624-627.
[8] 周丽君, 李姣姣, 孙燕, 王露, 钱蓉. 不同吻合方式对腹腔镜辅助远端胃癌根治术患者术后恢复的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(06): 642-645.
[9] 周福安, 陈戬. 经皮肾镜碎石取石术后肾功能恶化的围术期影响因素研究进展[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(06): 792-795.
[10] 陈伟东, 赵力, 罗辉, 张汉荣, 李金雨. 经皮肾镜碎石取石术后引起胸腔积液的防治[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(06): 796-799.
[11] 钟秋润, 严丹檎, 范小莉, 陈蓉, 罗坤. 腹股沟疝修补术后发生血清肿危险因素的Meta分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2025, 19(06): 701-706.
[12] 姜彤彤, 戎萍, 马融, 付乾芳, 张亚同, 赵书艺, 刘晖, 马榕, 李悦, 李瑞本. 抽动障碍儿童呼吸道感染后的临床特征及抽动症状加重的危险因素分析[J/OL]. 中华临床医师杂志(电子版), 2025, 19(06): 426-432.
[13] 单小洁, 胡欢欢, 张磊, 杨佳康, 刘建民, 甘丽芬, 徐立, 李红月, 李冬梅. 链式流程管理在急性脑卒中绿色通道CT检查中改善碘对比剂外渗的效果[J/OL]. 中华脑血管病杂志(电子版), 2025, 19(06): 477-482.
[14] 柴昌, 李定安, 姜进, 薛延华, 王衡. 前循环大血管闭塞性轻型卒中患者早期进展的危险因素及其补救性血管内治疗的临床疗效[J/OL]. 中华脑血管病杂志(电子版), 2025, 19(06): 503-510.
[15] 卢剑峰, 王亚云, 王佳宁, 苗丹. 心源性卒中危险因素的研究进展[J/OL]. 中华脑血管病杂志(电子版), 2025, 19(06): 550-554.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?