Santos Schmidt Augusto Frederico, Goncalves Anderson, Bustorff-Silva Joaquim Murray, Oliveira-Filho Antonio Gonçalves, Miranda Marcio Lopes, Oliveira Edison Rissato, Marba Sergio, Sbragia Lourenço
Departmento de Cirurgia, Universidade Estadual de Campinas, Rua Alexander Fleming, Campinas, Brazil.
J Matern Fetal Neonatal Med. 2012 Aug;25(8):1438-41. doi: 10.3109/14767058.2011.640366. Epub 2012 Apr 25.
Correction of gastroschisis may be accomplished by either primary or staged closure or even delayed primary closure after the use of a preformed silo. However, there is neither a consensus on the best approach nor established criteria to favor one method over the other. The aim of this paper was to investigate the role of intravesical pressure (IVP) as a tool to prevent abdominal compartment syndrome in newborns undergoing correction of abdominal wall defects.
We retrospectively analyzed 45 newborns with gastroschisis in whom trans-operative intravesical pressure was used to choose between primary or staged closure. A threshold of 20 cm H(2)O was used and the outcomes between the two methods were compared.
In 24 children delayed primary closure was achieved while the remaining 21 underwent staged reduction and closure. There was no difference in the frequency of complications, time to begin oral feeding, length of parenteral nutrition or length of hospital stay between the children of the two groups. The incidence of temporary oliguria or anuria, averaged 33% and it was similar in both groups of children.
The data here presented suggests that monitoring intraoperative IVP during correction of gastroschisis may help to select children in whom staged closure is necessary, keeping their complication rate and overall outcome similar to that of children undergoing delayed primary closure. Further prospective studies should investigate more deeply the correlation between type of closure and the development of a compartment syndrome.
腹裂修补术可通过一期修补、分期修补，甚至在使用预制袋后延迟一期修补来完成。然而，对于最佳手术方式尚无共识，也没有既定标准表明哪种方法优于另一种。本文旨在研究膀胱内压（IVP）作为预防腹壁缺损修补新生儿发生腹腔间隔室综合征工具的作用。
我们回顾性分析了45例腹裂新生儿，术中通过膀胱内压来选择一期修补或分期修补。采用20 cm H₂O的阈值，并比较两种方法的结果。
24例患儿实现了延迟一期修补，其余21例接受了分期还纳和修补。两组患儿的并发症发生率、开始经口喂养的时间、肠外营养时间或住院时间均无差异。两组患儿中，暂时性少尿或无尿的发生率平均为33%，且相似。
本文所呈现的数据表明，在腹裂修补术中监测术中膀胱内压可能有助于选择需要分期修补的患儿，使其并发症发生率和总体结局与接受延迟一期修补的患儿相似。进一步的前瞻性研究应更深入地探讨修补类型与间隔室综合征发生之间的相关性。
