Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, United Kingdom.
J Pediatr Surg. 2011 Jun;46(6):1070-5. doi: 10.1016/j.jpedsurg.2011.03.033.
Although gastroschisis infants usually have a good outcome, there remains a cohort of babies who fare poorly. We inquired whether the presence of bowel dilatation in utero is predictive of postnatal course in infants with gastroschisis.
We compared the clinical course of infants who had bowel dilatation with those who did not. Bowel dilatation was defined as more than 20 mm in cross-sectional diameter on ultrasound at any gestational age. Outcome measures used were length of time of parenteral nutrition, death, and surgery for intestinal failure.
A review of 170 infants with gastroschisis identified 74 who had dilatation of more than 20 mm (43.5%). There was no significant difference in the incidence of intestinal atresia in those with bowel dilatation and those without (P = .07). Those with bowel dilatation spent a longer period on parenteral nutrition. There were significantly more deaths in the group with bowel dilatation (P = .01). There was no significant difference in the number of infants requiring surgery for intestinal failure between the 2 groups (P = .47).
We found that sonographically detected bowel dilatation more than 20 mm in utero in fetuses with gastroschisis may have value in predicting clinically significant adverse postnatal outcomes.
尽管先天性腹裂患儿的预后通常较好，但仍有一部分患儿的病情较差。我们研究了胎儿肠管扩张是否可以预测先天性腹裂患儿的出生后病程。
我们比较了肠管扩张患儿与非扩张患儿的临床病程。肠管扩张定义为在任何胎龄时超声检查的肠管横径超过 20mm。使用的转归指标包括肠外营养时间、死亡和肠衰竭手术。
对 170 例先天性腹裂患儿的回顾性研究中，有 74 例（43.5%）患儿肠管扩张超过 20mm。肠管扩张患儿与非扩张患儿的肠闭锁发生率无显著差异（P=0.07）。肠管扩张患儿的肠外营养时间较长。肠管扩张组的死亡率显著更高（P=0.01）。两组患儿需要手术治疗肠衰竭的数量无显著差异（P=0.47）。
我们发现，胎儿先天性腹裂时超声检查发现肠管扩张超过 20mm 可能有助于预测具有临床意义的不良转归。
