신생아 위천공에서 미숙아와 만삭아의 임상양상 비교

Abstract

Purpose : The purpose of this study was to compare the clinical findings and mortality of gastric perforation between preterm and term infants. Methods : The medical records of neonates, admitted to the neonatal intensive care unit of Dongsan Medical Center for gastric perforation between July 1992 and June 2012, were reviewed retrospectively. The admission records of clinical findings and mortality were reviewed and statistically analyzed between preterm and term infants. Results : Nine infants were diagnosed with neonatal gastric perforation. Of the nine infants, the number of term infants was five and the number of male was eight. Of the four infants diagnosed with spontaneous gastric perforation, the number of preterm and term infants was three and one respectively. The anatomical location of perforation was greater curvature in all four preterm infants. However, various sites such as greater curvature (three infants) and antrum (two infants) were observed in five term infants. Mortality rate was tended to be lower in preterm infants compared to term infants, without statistical significance (25.0% vs. 40.0%, P>0.1). There was no mortality in four infants diagnosed with spontaneous gastric perforation. However, two infants diagnosed with necrotizing enterocolitis (NEC) all died. Conclusion : There was no significant difference in clinical findings and mortality of gastric perforation between preterm and term infants. The prognosis of spontaneous gastric perforation was good, however, mortality rate was tended to be higher in NEC than other causes (P=0.083).

목적 : 신생아 위천공의 임상양상과 결과에 대해 미숙아와 만삭아를 비교하여 알아보고자 하였다. 방법 : 1992년 7월부터 2012년 6월까지 20년간 계명대학교 동산의료원에서 위천공으로 수술한 신생아 9명을 후향적 의무기록을 통해 미숙아와 만삭아로 분류하여 임상적 양상과 사망률을 비교하였다. 결과 : 신생아 위천공 환자는 총 9명이었으며, 이 중 만삭아가 5례, 남아가 8례로 많았다. 자발성 위천공은 미숙아에서 3례(75%), 만삭아 에서는 1례(20%)였다. 천공부위는 미숙아의 경우 대만곡에서 4례(100%)였고, 만삭아는 대만곡 3례, 전정부 2례였다. 사망률은 미숙아에서 통계적으로 유의하지는 않았지만 낮았으며(25.0% vs. 40.0%, P>0.1), 원인으로 자 연천공이 있었던 4례는 모두 생존하였고, 괴사성 장염이 있었던 2례는 모두 사망하였다. 결론 : 신생아 위천공의 임상양상과 사망률은 미숙아와 만삭아에 따른 의미있는 차이가 없었다. 자연천공 환자에서는 예후가 좋았던 반면, 괴사성 장염이 있는 경우 사망률이 높았지만 통계적으로 유의하지는 않았다(P=0.083).