Alali J S, Tander B, Malleis J, Klein M D
Wayne State University/Detroit Medical Center, Pediatric Surgery, Detroit, United States.
Eur J Pediatr Surg. 2011 Mar;21(2):99-102. doi: 10.1055/s-0030-1267977. Epub 2010 Nov 22.
Since 30 years, we have attempted to repair gastroschisis as early as possible, often even in the delivery room. We examined 12 recent years of patient records to evaluate the effect of immediate repair and other factors on the outcome of gastroschisis.
We reviewed the medical records of patients presenting with gastroschisis (87) at the Children's Hospital of Michigan between 1998 and 2009. Data were evaluated specifically to determine the effect of the place of repair [obstetric hospital ("DR") vs. children's hospital ("OR")], the time of repair [less than an hour after delivery ("IR") or more than one hour ("ER")], and the type of repair [primary fascial repair and skin closure ("PR") vs. staged repair ("SR")].
Patients in the PR group were more likely to spend one week or less on MV (66% in PR vs. 11% in SR, p<0.01). Patients in the DR group were more likely to spend 2 weeks or less on TPN, as were patients in the PR group (51% in PR vs. 17% in SR, p<0.01). Patients in the PR group were more likely to stay in hospital for less than 3 weeks, but the IR and ER groups had almost same hospital stay. Major associated anomalies were present in 19 patients (29%). These patients and those with little or no peel tended to outperform those with peel in each of our outcome measures.
Repair immediately after delivery is beneficial in terms of achieving primary closure of the defect, leading to shorter times on assisted ventilation and parenteral nutrition, and shorter hospital stays.
30年来，我们一直试图尽早修复腹裂，甚至常常在产房就进行修复。我们查阅了近年来12年的患者记录，以评估即刻修复及其他因素对腹裂治疗结果的影响。
我们回顾了1998年至2009年间密歇根儿童医院腹裂患者（87例）的病历。具体评估数据以确定修复地点[产科医院（“DR”）与儿童医院（“OR”）]、修复时间[出生后不到1小时（“IR”）或超过1小时（“ER”）]以及修复类型[一期筋膜修复和皮肤缝合（“PR”）与分期修复（“SR”）]的影响。
PR组患者使用机械通气一周或更短时间的可能性更大（PR组为66%，SR组为11%，p<0.01）。DR组患者使用全胃肠外营养两周或更短时间的可能性更大，PR组患者也是如此（PR组为51%，SR组为17%，p<0.01）。PR组患者住院时间少于3周的可能性更大，但IR组和ER组的住院时间几乎相同。19例患者（29%）存在主要相关畸形。在我们的各项治疗结果指标中，这些患者以及那些几乎没有或没有腹膜覆盖的患者往往比有腹膜覆盖的患者表现更好。
出生后即刻修复有利于实现缺损的一期闭合，从而缩短辅助通气和肠外营养的时间以及缩短住院时间。
