Niramis Rangsan, Suttiwongsing Arada, Buranakitjaroen Veera, Rattanasuwan Tongkao, Tongsin Achariya, Mahatharadol Varaporn, Anuntkosol Maitree, Watanatittan Sukawat
Department of Surgery, Queen Sirikit National Institute of Child Health, College of Medicine, Rangsit University, Bangkok, Thailand.
J Med Assoc Thai. 2011 Aug;94 Suppl 3:S49-56.
The aim of the present study was to review the experience in management of neonates with gastroschisis and analyze the differences in the clinical outcome during a 24-year period.
A retrospective study of patients with gastroschisis treated at Queen Sirikit National Institute of Child Health (QSNICH) between 1986 and 2009 was conducted. Patients' information was compared between the first period (1986-1997) and the second period (1998-2009) regarding demographic data, modes of operative procedures and results of the treatment. The statistical differences were analyzed by the Chi-square, Fisher exact and student t-test with a p-value less than 0.05 considered significant.
During a 24-year period, 919 neonates with gastroschisis were treated at QSNICH; 342 cases (161 males and 181 females) in the first 12-year period and 577 cases (295 males and 282 females) in the second 12-year period. The incidence of gastroschisis at Rajavithi Hospital was 0.26: 1,000 live births in the first period and 1.03: 1,000 live births in the second period. Average birth weight of the patients and average maternal age in both periods were not significantly different (p > 0.05). Congenital anomalies were found in approximately 15% of the patients in each period. Regarding modes of the operative treatment, primary closure of the abdominal wall defect was attempted in 23.7% of the patients during the first period and increased to 44% in the second period. The overall survival rate in the second period was better than the first period with statistical significance (92.4% vs. 75.4%, p < 0.001). In addition, complications in the second period were less than those in the first period, except for necrotizing enterocolitis, which was more frequent in the second period.
The obvious differences in patients with gastroschisis during the 24-year period were the increased incidence, increased successful primary closure of the abdominal wall defect and increased overall survival rate between 1998-2009. Improvement of the clinical outcomes reflected improved neonatal care including surgical techniques, parenteral nutrition, respiratory care and anesthetic practice.
本研究旨在回顾先天性腹裂新生儿的治疗经验，并分析24年间临床结局的差异。
对1986年至2009年在诗丽吉王后国家儿童健康研究所（QSNICH）接受治疗的先天性腹裂患者进行回顾性研究。比较了第一阶段（1986 - 1997年）和第二阶段（1998 - 2009年）患者的人口统计学数据、手术方式和治疗结果。采用卡方检验、Fisher精确检验和学生t检验分析统计学差异，p值小于0.05被认为具有统计学意义。
在24年期间，QSNICH共治疗了919例先天性腹裂新生儿；前12年期间有342例（男161例，女181例），后12年期间有577例（男295例，女282例）。拉贾维蒂医院先天性腹裂的发病率在第一阶段为0.26:1000活产，在第二阶段为1.03:1000活产。两个阶段患者的平均出生体重和产妇平均年龄无显著差异（p>0.05）。每个阶段约15%的患者发现有先天性畸形。关于手术治疗方式，第一阶段23.7%的患者尝试一期关闭腹壁缺损，第二阶段增加到44%。第二阶段的总体生存率优于第一阶段，具有统计学意义（92.4%对75.4%，p<0.001）。此外，第二阶段的并发症少于第一阶段，但坏死性小肠结肠炎在第二阶段更为常见。
在这24年期间，先天性腹裂患者的明显差异在于发病率增加、腹壁缺损一期关闭成功率提高以及1998 - 2009年期间总体生存率提高。临床结局的改善反映了新生儿护理水平的提高，包括手术技术、肠外营养、呼吸护理和麻醉实践。
