Wright Naomi J, Zani Augusto, Ade-Ajayi Niyi
Department of Paediatric Surgery, Kings College Hospital, London, United Kingdom.
Afr J Paediatr Surg. 2015 Jan-Mar;12(1):1-6. doi: 10.4103/0189-6725.150924.
The aim was to compare gastroschisis (GS) epidemiology, management and outcome in low-income countries (LIC) in Sub-Saharan Africa (SSA) with middle- (MIC) and high-income countries (HIC).
A 10-question survey was administered at the 2012 Pan-African Paediatric Surgery Association Congress. RESULTS are presented as median (range); differences were analysed using contingency tests.
A total of 82 delegates (28 countries [66 institutions]) were divided into LIC (n = 11), MIC (n = 6) and HIC (n = 11). In LIC, there were fewer surgeons and more patients. LIC reported 22 cases (1-184) GS/institution/year, compared to 12 cases (3-23)/institution/year in MICs and 15 cases (1-100)/institution/year in HICs. Antenatal screening was less readily available in LIC. Access to parenteral nutrition and neonatal intensive care in LIC was 36% and 19%, compared to 100% in HIC. Primary closure rates were similar in LIC and HIC at 58% and 54%, respectively; however, the majority of staged closure utilised custom silos in LIC and preformed silos in HIC. In LIC, mortality was reported as >75% by 61% delegates and 50-75% by 33%, compared to <25% by 100% of HIC delegates (P < 0.0001).
Gastroschisis is a problem encountered by surgeons in SSA. Mortality is high and resources in many centres inadequate. We propose the implementation of a combined epidemiological research, service delivery training and resource provision programme to help improve our understanding of GS in SSA whilst attempting to improve outcome.
目的是比较撒哈拉以南非洲（SSA）的低收入国家（LIC）与中等收入国家（MIC）和高收入国家（HIC）的腹裂（GS）流行病学、管理及治疗结果。
在2012年泛非儿科学会外科大会上进行了一项包含10个问题的调查。结果以中位数（范围）呈现；差异采用列联检验进行分析。
共有82名代表（来自28个国家[66个机构]）被分为LIC组（n = 11）、MIC组（n = 6）和HIC组（n = 11）。在LIC，外科医生较少而患者较多。LIC报告每个机构每年有22例（1 - 184例）GS，相比之下，MIC为每个机构每年12例（3 - 23例），HIC为每个机构每年15例（1 - 100例）。LIC中产前筛查较难获得。LIC中肠外营养和新生儿重症监护的可及率分别为36%和19%，而HIC为100%。LIC和HIC的一期闭合率相似，分别为58%和54%；然而，LIC中大多数分期闭合使用定制的储袋，而HIC使用预制储袋。在LIC，61%的代表报告死亡率>75%，33%报告死亡率为50 - 75%，相比之下，100%的HIC代表报告死亡率<25%（P < 0.0001）。
腹裂是SSA外科医生面临的一个问题。死亡率高且许多中心资源不足。我们建议实施一项综合的流行病学研究、服务提供培训和资源供应计划，以帮助提高我们对SSA地区腹裂的认识，同时试图改善治疗结果。
