Pediatric Surgical Unit, Sheffield Children's Hospital, Sheffield, United Kingdom.
J Pediatr Surg. 2009 Nov;44(11):2126-9. doi: 10.1016/j.jpedsurg.2009.06.006.
Previous single-center studies have reported favorable outcomes when preformed silos (PFS) are used for the staged reduction of gastroschisis. The aim of this study was to assess the frequency and nature of complications associated with PFS in a large population and provide an insight into the practicalities of their routine use.
A retrospective review was carried out of all cases of gastroschisis managed with PFS in 4 UK neonatal surgical units for a 6-year period.
One hundred fifty infants were included, and 139 (92.7%) silos were applied at cot side (no sedation, n = 93). Median silo size was 4 cm, and time of application was 2.5 hours. Enlarging the defect by incision of fascia was required in 17 (11%). Defect closure was performed at a median of 4 days (0-47) with 93 (62%) being at cot side. Methods of closure were adhesive strips/dressings (n = 94), sutures (n = 48), and patch (n = 8). Discoloration of the viscera occurred in 16 (11%), managed successfully by simple methods (change of PFS, aspirating the stomach, or incision of the defect fascia) (n = 8), conversion to operative silo (n = 3), and operative reduction (n = 1). Four required bowel resection. Other complications included missed atresia (n = 5; 3.3%) and nectrotizing enterocolitis (n = 11; 7%). There were 5 deaths in the series (3.3%).
Staged reduction of gastroschisis with PFS is simple, convenient, and safe. The low rates of associated complications and mortality appear favorable when compared to infants managed with more traditional techniques. We recommend that PFS should be used for the routine management of gastroschisis.
先前的单中心研究报告称，使用预制式沙笼（PFS）分期缩小腹裂时，结果较为理想。本研究旨在评估在大规模人群中使用 PFS 相关并发症的发生频率和性质，并深入了解其常规应用的实际情况。
对在英国 4 家新生儿外科单位接受 PFS 治疗的 150 例腹裂患儿进行回顾性分析，研究时间为 6 年。
150 例患儿中，139 例（92.7%）在产床边应用了 PFS（未镇静，n=93）。沙笼中位大小为 4cm，应用时间为 2.5 小时。17 例（11%）需要通过切开筋膜来扩大缺损。中位关闭时间为 4 天（0-47 天），其中 93 例（62%）在产床边完成。关闭方法包括使用粘性条/敷料（n=94）、缝合（n=48）和补丁（n=8）。16 例（11%）发生内脏变色，通过简单方法（更换 PFS、抽吸胃部或切开缺损筋膜）成功处理（n=8），3 例转为手术沙笼，1 例手术复位。4 例患儿需要进行肠切除术。其他并发症包括漏诊狭窄（n=5；3.3%）和坏死性小肠结肠炎（n=11；7%）。本研究中共有 5 例患儿死亡（3.3%）。
使用 PFS 分期缩小腹裂操作简单、方便且安全。与使用传统技术治疗的患儿相比，其相关并发症和死亡率似乎较低。我们建议将 PFS 用于腹裂的常规治疗。
