Initial Percutaneous Peritoneal Drainage for Newborn Intestinal Perforation in Very-Low-Birth-Weight Infants

以經皮腹腔引流做爲低體重新生兒腸穿孔之第一線手術治療

陳肇真(Chau-Jing Chen) ； 許凱熙(Kai-Hsi Hsu)

《Formosan Journal of Surgery》 43卷4期 (2010/08) Pp. 174-180

https://doi.org/10.29833/FJS.201008.0002

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.

並列摘要

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.

並列關鍵字

focal intestinal perforation ； necrotizing enterocolitis ； laparotomy ； newborn intestinal perforation ； percutaneous peritoneal drainage