Shah R, Woolley M M
Department of Surgery, Children's Hospital of Los Angeles, CA.
J Pediatr Surg. 1991 Jul;26(7):788-90. doi: 10.1016/0022-3468(91)90139-k.
Controversy exists over the best method of treating gastroschisis with concomitant intestinal atresia because the mortality in such patients is still high. We present our experience of 74 neonates with gastroschisis seen over a 17-year period. Four patients (5.5%) had intestinal atresia; 1 had only one small bowel atresia, 2 had double areas of atresia (one in the mid small bowel and the other in the proximal colon), and the remaining 1 had multiple areas of atresia. Atresia with gastroschisis conventionally has been treated by either primary anastmosis or by exteriorization. Three of the patients were treated by replacing the atretic bowel into the abdomen initially and exploring later (1 to 3 weeks) when the bowel appeared much more healthy, making the anastomosis easier and more secure. One patient with extreme jejunal dilatation was treated by creation of a Mikulicz fistula. All 4 of the patients survived the newborn period, but one of them died at 1 year of age due to total parenteral nutrition-induced chronic liver failure. Our experience is presented to emphasize this uncommonly used approach to this complex problem because it seems to be associated with a lower morbidity and mortality than other conventional approaches.
对于伴有肠闭锁的腹裂最佳治疗方法存在争议，因为这类患者的死亡率仍然很高。我们介绍了17年间诊治的74例腹裂新生儿的经验。4例患者（5.5%）伴有肠闭锁；1例仅有一处小肠闭锁，2例有两处闭锁区域（一处在小肠中部，另一处在近端结肠），其余1例有多处闭锁区域。传统上，腹裂合并肠闭锁的治疗方法是一期吻合或外置。3例患者最初将闭锁肠段回纳腹腔，待肠管看起来健康得多（1至3周）后再进行探查，这样吻合更容易且更安全。1例空肠极度扩张的患者采用了米库利兹瘘管造口术治疗。所有4例患者均度过了新生儿期，但其中1例在1岁时因全胃肠外营养导致的慢性肝功能衰竭死亡。我们介绍这一经验是为了强调这种针对这一复杂问题的不常用方法，因为它似乎比其他传统方法的发病率和死亡率更低。
