Skarsgard Erik D, Claydon Jennifer, Bouchard Sarah, Kim Peter C W, Lee Shoo K, Laberge Jean-Martin, McMillan Douglas, von Dadelszen Peter, Yanchar Natalie
Department of Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
J Pediatr Surg. 2008 Jan;43(1):30-4; discussion 34. doi: 10.1016/j.jpedsurg.2007.09.011.
Outcomes studies for gastroschisis are constrained by small numbers, prolonged accrual, and nonstandardized data collection. The aim of this study is to create a national pediatric surgical network and database for gastroschisis (GS) that tracks cases from diagnosis to hospital discharge.
The 16-center network serves a population of 32 million. Gastroschisis cases are ascertained at prenatal diagnosis. Perinatal data include maternal risk and fetal ultrasound variables, delivery plan and outcome, a postnatal bowel injury score, intended and actual surgical treatment, and neonatal outcomes. Institutional review board-approved data collection conforms to regional privacy legislation. Deidentified data are centralized and accessible for research through the network steering committee.
To date, 114 cases of pre- and/or postnatal gastroschisis have been uploaded. Of 106 live-born infants (40 [38%] by cesarean delivery), 100 had complete records, and overall survival to discharge was 96%, with a mean survivor length of stay (LOS) of 46 days. Infants treated with attempted urgent closure (61%) had significantly shorter LOS (42 vs 57 days; P = .048) but comparable LOS compared with those treated with silos and delayed closure. Fetal bowel dilation 18 mm or greater did not predict a difference in outcome.
Population-based databases allow rapid case accrual and enable studies that should aid in the identification of optimal perinatal treatment.
腹裂的结局研究受到病例数量少、入组时间长和数据收集不规范的限制。本研究的目的是创建一个全国性的小儿外科网络和腹裂（GS）数据库，跟踪从诊断到出院的病例。
这个16中心的网络服务于3200万人口。腹裂病例在产前诊断时确定。围产期数据包括母亲风险和胎儿超声变量、分娩计划和结局、产后肠损伤评分、预期和实际手术治疗以及新生儿结局。经机构审查委员会批准的数据收集符合地区隐私法规。去识别化的数据被集中起来，可通过网络指导委员会进行研究访问。
迄今为止，已上传了114例产前和/或产后腹裂病例。在106例活产婴儿中（40例[38%]通过剖宫产），100例有完整记录，出院时的总体生存率为96%，存活者的平均住院时间（LOS）为46天。尝试紧急关闭治疗的婴儿（61%）住院时间明显较短（42天对57天；P = 0.048），但与使用肠袋和延迟关闭治疗的婴儿相比，住院时间相当。胎儿肠扩张18毫米或更大并不能预测结局的差异。
基于人群的数据库允许快速积累病例，并能开展有助于确定最佳围产期治疗方法的研究。
