Neonatal Necrotizing Enterocolitis

新生兒的壞死性腸炎

黃倫奕(Lun-Yick Wong)

《中華放射線醫學雜誌》 7卷1期 (1982/03) Pp. 53-60

摘要

這種發生在新生兒死亡率相當高的壞死性腸炎，自從Genersich在1891年報告第一個病例後，以後也有不少較為完整的文獻報告。我們從1978年3月到1981年12月的3年9個月中也發現11個病例。每個病例的腹部愛克斯光片都呈現不同程度的腸壁內氣體（這種現象是因為腸粘膜潰爛導致腸腔氣體入侵腸內壁，可作為新生完．壞死性腸炎診斷的依據）。四個病例有肝靜脈氣體入侵，有一病例有氣腹，後兩者顯示極不良的預後，這些新生兒在我們的病例中全都死亡，有兩病例合併巨結腸病的經開刀後活著出院，另兩例經加護治療沒有開刀而痊愈。生存率為36%，死亡率為64%，較諸其他文獻沒有太大的差異。
診斷主要靠臨床症狀和腹部愛克斯光“病理所見為不同程度的粘膜潰瘍和壞死且常伴有釉膜下出血和氣體。
如警覺性高和能作早期診斷和治療，其預後情形當會改善。

並列摘要

A review of 11 cases of necrotizing enterocolitis from March 1978 to December 1981 at the Mackay Memorial Hospital with the diagnosis clinically made or strongly suspected, three were confirmed by autopsy. Clinically, most are premature infants with below average birth weight varying from 1.45Kg to 4.7Kg. The most common signs and symptoms are abdominal distension, diarrhea, vomiting, dyspnea(RDS), jaundice and fever; the most important and diagnostic radiographic sign is submucosal collection of gas as curvilinear streaks of lines of bubbles called pneumatosis intestinalis, this is frequently associated with a peculiar frothy pattern (Fig. 1) thought to represent a combination of bowel wall gas with mixed gas and blood clots in the adjacent lumen.
The lesions are predominantly, located in the lower ileum, cecum and ascending colon with varying degree of mucosal ulcerations and necrosis frequently accompanied by submucosal hemorrhage.
Septicemia with gas in the portal vein and pneumoperitoneum is a terminal manifestation and most infants die.
The etiology is not known but factors such as hypoxia with reflex vasospasm, dehydration, infections, hypersensitivity of bowel mucosa to endotoxins of. gram. negative bacilli and carbohydrate intolerance. Overall intestinal ischemia either from reflex vasospasm or vascular occlusion is favored.

並列關鍵字

Pneumatosis intestinalis ； abdominal distension ； necrotizing enterocolitis portal vein air