| 摘要 |
Objective: Newborn intestinal perforation (NIP) in very-low-birth-weight (VLBW)
premature neonates is a complex disease that includes focal intestinal perforation
(FIP) and necrotizing enterocolitis (NEC) causing perforation. Surgical procedures
for managing VLBW neonates with NIP generally include percutaneous peritoneal
drainage (PPD) and laparotomy. The optimal choice between these two procedures
remains controversial. The aim of this study is to evaluate the value of PPD as the
initial management for patients with VLBW and NIP.
Methods: Between 1989 and 2005, a total of 36 VLBW infants with NIP undergoing
either laparotomy or PPD at National Cheng-Kung University Hospital (NCKUH)
were included in this study for evaluation and comparison of the clinical effects in
relation to these two methods of surgical intervention.
Results: There were 19 patients with FIP and 17 patients with NEC. In all 36
VLBW patients with NIP, those undergoing PPD, as compared with those
undergoing laparotomy alone, were associated with a better survival rate and a
lower complication rate (P=0.036 and 0.015, respectively). Patients with NEC,
compared to those with FIP, treated with either procedures, were significantly
associated with an increased rate of complication (P<0.0001).
Conclusions: This study demonstrates that initial PPD, compared with
laparotomy, is a less radical procedure that is associated with better outcomes and
less complications in VLBW neonates with NIP. However, a larger-scale study may
be necessary for justifying PPD as the optimal initial surgical treatment of choice in
these patients, especially those with NEC. |
