van Eijck Floortje C, Wijnen Rene M H, van Goor Harry
Department of General Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
J Pediatr Surg. 2008 Mar;43(3):479-83. doi: 10.1016/j.jpedsurg.2007.10.027.
BACKGROUND/PURPOSE: Adhesive small bowel obstruction (SBO) is a feared complication after correction of abdominal wall defects in neonates. Knowledge of its incidence and potential risk factors in a well-documented group with strict follow-up is needed to guide preventive measures.
Records of 170 neonates with abdominal wall defects, 59 gastroschisis (GS) and 111 omphalocele (OC), were reviewed focusing on SBO. Risk of SBO was calculated, and potential risk factors were analyzed. Long-term complaints possibly associated with adhesions were assessed through questionnaire.
One hundred forty-seven neonates were operated on, 12 were treated nonoperatively, and 11 patients died shortly after birth. Defects were primarily closed in 128, 7 neonates needed prosthetic mesh, and 12 had a silastic sac inserted. Twenty-six (18%) neonates had SBO, 14 (25%) of 55 with GS, and 12 (13%) of 92 with OC (P = .06). Of the 26 with SBO, 26 (88%) needed laparotomy. Four patients died because of SBO. Most episodes (85%) were in the first year. Sepsis and fascia dehiscence were predicting risk factors for SBO. Abdominal pain and constipation were frequent long-term complaints not significantly associated with SBO.
Adhesive SBO is a frequent and serious complication in the first year after treatment of congenital abdominal wall defects. Sepsis and fascial dehiscence are predictive factors.
背景/目的：粘连性小肠梗阻（SBO）是新生儿腹壁缺损修复术后令人担忧的并发症。需要了解在有详细记录且严格随访的群体中其发病率及潜在风险因素，以指导预防措施。
回顾了170例腹壁缺损新生儿的记录，其中59例为腹裂（GS），111例为脐膨出（OC），重点关注SBO。计算SBO的风险，并分析潜在风险因素。通过问卷调查评估可能与粘连相关的长期不适。
147例新生儿接受了手术，12例接受非手术治疗，11例出生后不久死亡。128例主要进行了缺损闭合，7例新生儿需要使用人工补片，12例插入了硅橡胶囊。26例（18%）新生儿发生SBO，55例GS患儿中有14例（25%），92例OC患儿中有12例（13%）（P = 0.06）。26例发生SBO的患儿中，26例（88%）需要剖腹手术。4例患儿因SBO死亡。大多数发作（85%）发生在第一年。脓毒症和筋膜裂开是SBO的预测风险因素。腹痛和便秘是常见的长期不适，与SBO无显著相关性。
粘连性SBO是先天性腹壁缺损治疗后第一年常见且严重的并发症。脓毒症和筋膜裂开是预测因素。
