Gelas Thomas, Gorduza Daniela, Devonec Simone, Gaucherand Pascal, Downham Esther, Claris Olivier, Dubois Rémi
Department of Pediatric Surgery, Hôpital Edouard Herriot, Hospices Civils de Lyon, and Université Claude Bernard Lyon 1, Lyon, France.
Pediatr Surg Int. 2008 Sep;24(9):1023-9. doi: 10.1007/s00383-008-2204-y. Epub 2008 Jul 31.
There are some evidence to suggest that careful antenatal monitoring, scheduled preterm delivery and immediate abdominal wall closure may reduce gastroschisis morbidity. We hypothesised that the advantages of a scheduled preterm delivery balance possible complications related to prematurity. A retrospective study was performed including all cases of gastroschisis born between 1990 and 2004 (n = 69). Cases were categorised in two groups. Group 1 contained gastroschisis cases born between 1990 and 1997. Group 2 contained cases occurring since 1997, when a new management pathway for gastroschisis was established: weekly evaluation of the foetal gut by ultrasound (>28 weeks), corticosteroids, and delivery by scheduled caesarean section at 35 weeks (before if evidence of bowel compromise was present). The primary endpoints of this study were the initiation of oral feeding and the number of re-operation for intestinal obstruction. There was a significantly faster initiation of oral feeding (P < 0.0001), however, duration of parenteral nutrition (34 vs. 38 days) and hospital discharge (53 vs. 58.5 days) was not reduced. There was no complication due to prematurity in group 2. Postoperative outcome was improved with less need for muscular stretching or prosthetic patch and less re-operation for intestinal obstruction (P < 0.05). Scheduled and elective preterm delivery facilitates surgical procedure and shortens the time to first feeding. A delivery at 35 weeks (preferring vaginal delivery) seems to be a good compromise between risks related to prematurity and complications related to intestinal peel.
有证据表明，仔细的产前监测、计划早产和立即关闭腹壁可能会降低腹裂的发病率。我们假设计划早产的优势可平衡与早产相关的可能并发症。进行了一项回顾性研究，纳入了1990年至2004年出生的所有腹裂病例（n = 69）。病例分为两组。第1组包含1990年至1997年出生的腹裂病例。第2组包含自1997年以来的病例，自那时起建立了一种新的腹裂管理途径：在超声检查（>28周）时每周评估胎儿肠道，使用皮质类固醇，并在35周时通过计划剖宫产分娩（如果有肠道受损证据则提前）。本研究的主要终点是开始经口喂养和肠梗阻再次手术的次数。经口喂养开始明显更快（P < 0.0001），然而，肠外营养持续时间（34天对38天）和出院时间（53天对58.5天）并未缩短。第2组没有因早产出现并发症。术后结果得到改善，肌肉拉伸或使用人工补片的需求减少，肠梗阻再次手术的需求减少（P < 0.05）。计划和选择性早产便于手术操作并缩短首次喂养时间。35周分娩（优先选择阴道分娩）似乎是早产相关风险和肠道剥离相关并发症之间的良好折衷。
