腹裂的结局：对在得克萨斯州加尔维斯顿出生的腹裂婴儿的20年病例回顾

Outcome of gastroschisis: a 20-year case review of infants with gastroschisis born in Galveston, Texas.

作者信息

Eggink B Hannie, Richardson C Joan, Malloy Michael H, Angel Carlos A

机构信息

Division of Neonatology, Department of Pediatrics, University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA.

出版信息

J Pediatr Surg. 2006 Jun;41(6):1103-8. doi: 10.1016/j.jpedsurg.2006.02.008.

DOI:10.1016/j.jpedsurg.2006.02.008

PMID:16769342

Abstract

BACKGROUND/PURPOSE: In the past decade, the preferred method of closure of gastroschisis at our institution has been staged reduction using a silo with repair on an elective basis (SR) rather than primary surgical closure (PC). We performed a 20-year case review of infants with gastroschisis at a university hospital to compare these shifts in management and to determine factors affecting outcome.

METHODS

Seventy-two cases were reviewed from 1983 to 2003. Times to first and full feeds were outcome variables for statistical analysis.

RESULTS

The prevalence of gastroschisis increased from 0.03% to 0.1% since 1983. Patients had low birth weights (mean = 2294 g) and were borderline premature (mean = 35.8 weeks). Only 3% of the infants were African American. There was a high rate of cesarean deliveries (57%). Ten patients (15%) had gastroschisis complicated by liver herniation, intestinal atresia(s), and/or necrosis/perforation. Most patients were managed by SR (67%). Eight percent of the infants died, 9% developed necrotizing enterocolitis, and 50% had other gastrointestinal complications. Twenty-seven percent of the infants managed with SR did not need initial mechanical ventilation. However, the patients who underwent SR were ventilated longer after birth as compared with those who underwent PC (P < .08). Infants with a complicated gastroschisis had significantly longer times to first and full feeds (P < .001). Patients managed with SR took significantly longer to reach full feeds (P = .001), and there was a trend of starting feeds later (P = .06). When patients with a complicated gastroschisis were excluded, the differences between the SR and PC groups were even greater (P = .01; P < .001).

CONCLUSIONS

In our patient population, the prevalence of gastroschisis increased by more than 400% since 1983. The defect was rare in African-American infants. Management by SR was associated with longer ventilation times and longer times to first and full feeds for both uncomplicated and complicated gastroschisis cases.

摘要

背景/目的：在过去十年中，我院治疗腹裂的首选方法是采用袋状法分期还纳并择期修补（SR），而非一期手术缝合（PC）。我们对一家大学医院收治的腹裂婴儿进行了为期20年的病例回顾，以比较这些治疗方法的转变，并确定影响预后的因素。

方法

回顾了1983年至2003年期间的72例病例。首次喂奶时间和完全喂奶时间作为统计分析的预后变量。

结果

自1983年以来，腹裂的发病率从0.03%上升至0.1%。患儿出生体重低（平均2294克），接近早产（平均35.8周）。只有3%的婴儿是非裔美国人。剖宫产率很高（57%）。10例患者（15%）的腹裂合并肝疝、肠闭锁和/或坏死/穿孔。大多数患者采用SR治疗（67%）。8%的婴儿死亡，9%发生坏死性小肠结肠炎，50%有其他胃肠道并发症。27%接受SR治疗的婴儿不需要初始机械通气。然而，与接受PC治疗的婴儿相比，接受SR治疗的婴儿出生后机械通气时间更长（P < 0.08）。合并腹裂的婴儿首次喂奶和完全喂奶时间明显更长（P < 0.001）。采用SR治疗的患者完全喂奶所需时间明显更长（P = 0.001），且开始喂奶时间有延迟趋势（P = 0.06）。排除合并腹裂的患者后，SR组和PC组之间的差异更大（P = 0.01；P < 0.001）。