재태연령 25주 이하 초극소 미숙아에서 괴사 장염에 의한 장 천공의 수술적치료 성적
Operational Outcomes of Bowel Perforation Due to Necrotizing Enterocolitis in Preterm Infants of Less than or Equal to 25 Weeks’ Gestational Age
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목적: 초극소 미숙아의 생존율은 지속적으로 증가하고 있으나, 환아들의 괴사 장염과 이에 의한 장 천공의 체계적인임상 경과 보고는 부족한 실정이다. 이에 본 연구는 재태연령 25주 이하 초미숙아에서 괴사 장염으로 장 천공이발생한 경우 진단과 수술 시행 후 경과와 예후를 보고하였다. 방법: 2000년 1월 1일부터 2012년 12월 31일까지 삼성서울병원에서 출생하여 신생아 집중 치료실에 입원한 25주 이하초미숙아의 경과를 후향적으로 조사하였다. 괴사 장염으로 인하여 장 천공이 발생하여 수술을 시행한 경우의 인구학적 특징과 임상적 특징, 진단과 예후를 조사하였으며 수술 후 생존군과 사망군간의 인구학적 인자와 예후를분석하였다. 결과: 25주 이하의 초미숙아에서 괴사 장염의 발병률은 재태연령 22주 21.9%, 23주 18.3%, 24주 12.1%, 25주 11.4%였고, 수술을 시행한 비율은 각 주수별로 22주 21.9%, 23주 12.7%, 24주 5.3%, 25주 10.0%였다. 괴사 장염 진단일은 평균 18.4±14.8일이고, 조기 괴사 장염 진단 전 수유 진행양은 16.7±8.6 cc/kg이었다. 장 천공으로 수술을 시행한 38명의 환아 중 사망아는 17명(44.7%), 생존아는 21명(55.3%)이었다. 수술 후 사망군에서 생존군보다 괴사장염 진단시 혈소판 수치가 유의하게 낮았다. 생존아의 장루 복원술은 수술 후 159.0±43.6일에 이루어졌으며,당시 몸무게는 3,566±1,118 g이었다. 완전 소장 절제술을 시행하여 현재까지 총 정맥영양을 지속하고 있는 1명의 환아를 제외하고는 모든 생존아에서 완전 장관영양에 성공하였고, 외래 추적 관찰 중인 환아 중 91.6%에서 교정 18개월까지 따라잡기 성장을 이루었다. 결론: 재태연령 25주 이하 초극소 미숙아군에서 괴사 장염이 발생하는 경우 71.7%에서 장 천공으로 인한 수술적 치료를 필요로 하였으나, 생존아의 대부분이 완전 장관 영양에 성공하여 퇴원하였으며 교정 18개월에 따라잡기 성장을 이루었다.
Abstract
Purpose: Even though the improved survival rate of extremely preterm infants, the incidence of necrotizing enterocolitis (NEC) requiring operation has not decreased. Thus, this report demonstrates our experience of clinical course of bowel perforation due to necrotizing enterocolitis in preterm infants of less than or equal to 25 weeks’ gestational age. Methods: We retrospectively reviewed the medical records of 38 infants who underwent an operation for bowel perforation because of NEC from January 2000 to December 2012 at Samsung Medical Center. Results: 38 infants out of a total 53 infants diagnosed with NEC required operation due to bowel perforation. The mortality rate was 44.7% (alive group n=21, dead group n=17). Age when NEC was diagnosed 18.4±14.8 days, mean enteral feeding volume on day of early NEC was 16.7±8.6 cc/kg. The platelet count was significantly lower in the dead group. All alive infants, with the exception of one infant who underwent total small bowel resection, were successful in full enteral feeding. Ostomy closure was performed 159.0±43.6 days after the initial operation. The average body weight at ostomy closure operation was 3,566±1,118 g. Conclusion: 71.7% of the premature with a gestational age of 25weeks or less with a diagnosis of NEC required operation due to bowel perforation. But the infants who survived showed successful establishment of full enteral feeding and achieved catch up growth at 18 months of corrected gestational age.
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