Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Pediatr Neonatol. 2010 Dec;51(6):320-5. doi: 10.1016/S1875-9572(10)60062-9.
Gastroschisis requires surgical management soon after birth. Few publications have reached conclusion regarding the differences of outcomes between primary closure (PC) and a staged repair with silo pouch reduction (SR); as the initial management of gastroschisis.
A retrospective review was conducted in 44 newborns with gastroschisis between 1996 and 2007 at Chang Gung Children's Hospital. We recorded and analyzed basic demographic data, including birth body weight, gestational age, size of the wall defect, initial operative procedure, outcomes, and mortality.
The male-to-female ratio was 21:23. Patients had a low birth body weight (2263 ± 539g, mean ± SD) and were borderline premature (gestational age = 36.3 ± 1.86 weeks). Thirty-two patients received PC and 12 received SR as the initial treatment. Seven of the newborn infants died because of delayed initial surgical intervention (n = 2), operation-related complications (n = 4), or underlying multiple congenital anomalies (n = 1). The mortality rate was 16%. When comparing PC and SR (excluding "complicated" gastroschisis), there were no significant differences in survival, days of ventilator use, days to reach full enteral feeding, and hospitalization.
PC and SR are comparable as initial treatment modalities for gastroschisis. In addition to underlying gastrointestinal anomalies, the factors that led to significant morbidity in our study were bowel gangrene or perforation resulting from postponed surgical management and the development of abdominal compartment syndrome.
先天性腹壁发育不全（gastroschisis）患儿出生后需立即接受外科治疗。目前仅有少数文献报道了一期直接缝合（primary closure，PC）与分期经皮硅胶膜袋法减张术（silo pouch reduction，SR）治疗先天性腹壁发育不全的临床结局差异。
回顾性分析 1996 年至 2007 年在我院出生的 44 例先天性腹壁发育不全患儿的临床资料，包括患儿的基本人口统计学数据（出生体质量、胎龄、腹壁缺损大小、初始手术方式、转归及病死率）。
男/女患儿比例为 21:23。患儿出生体质量低（2263 ± 539g），且胎龄接近早产（36.3 ± 1.86 周）。32 例患儿接受一期直接缝合，12 例患儿接受分期经皮硅胶膜袋法减张术治疗。7 例患儿因初次手术延误（2 例）、术后并发症（4 例）或合并多发先天畸形（1 例）死亡，病死率为 16%。排除“复杂型”先天性腹壁发育不全后，一期直接缝合与分期经皮硅胶膜袋法减张术治疗先天性腹壁发育不全的患儿在存活率、呼吸机使用时间、达到完全肠内喂养时间及住院时间等方面差异无统计学意义。
一期直接缝合与分期经皮硅胶膜袋法减张术治疗先天性腹壁发育不全的疗效相当。除了存在胃肠道畸形外，导致患儿严重并发症的原因还包括延迟手术治疗导致的肠管坏死穿孔和腹腔间隔室综合征的发生。
