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孤立的产前超声检查结果可预测腹裂的产后病程。

Isolated prenatal ultrasound findings predict the postnatal course in gastroschisis.

作者信息

Frybova Barbora, Vlk Radovan, Kokesova Alena, Rygl Michal

机构信息

Department of Paediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84, 15006, Prague 5, Czech Republic,

出版信息

Pediatr Surg Int. 2015 Apr;31(4):381-7. doi: 10.1007/s00383-015-3675-2. Epub 2015 Feb 20.

DOI:10.1007/s00383-015-3675-2
PMID:25697276
Abstract

PURPOSE

The aim of the study was to identify which prenatal ultrasonographic findings in fetuses with gastroschisis correlate with complicated postnatal outcome.

METHODS

Ultrasound findings at the 30th week of pregnancy and medical reports were statistically analyzed to identify independent prenatal ultrasonographic predictors of postnatal outcome.

RESULTS

Completed prenatal data were gathered from 64 pregnancies. Prenatal intra-abdominal bowel dilatation (cutoff 10 mm) correlated with the presence of atresia (p < 0.01), longer administration of parenteral nutrition, extended hospital stay (median 53 vs. 21 days; 68 vs. 36 days, both p < 0.05), and greater number of additional surgical procedures (p < 0.05). Infants with antenatal presence of thickened bowel wall (greater than or equal to 3 mm) required longer administration of parenteral nutrition (median 34 vs. 20 days; p < 0.01) and prolonged stay (median 44 vs. 37 days; p < 0.05). Presence of oligohydramnion (amniotic fluid index below 8 cm) was connected with longer administration of parenteral nutrition in newborns (median 30 vs. 16 days; p < 0.05).

CONCLUSION

The isolated presence of oligohydramnion with amniotic fluid index below 8 cm, thickened bowel wall equal to or more than 3 mm and the prenatal intra-abdominal dilatation with 10 mm cutoff had significant predictive value for the adverse postnatal outcome of patients with gastroschisis.

摘要

目的

本研究的目的是确定腹裂胎儿的哪些产前超声检查结果与产后复杂结局相关。

方法

对妊娠30周时的超声检查结果和医学报告进行统计分析,以确定产后结局的独立产前超声预测指标。

结果

收集了64例妊娠的完整产前数据。产前腹腔内肠管扩张(截断值10 mm)与闭锁的存在相关(p < 0.01),肠外营养使用时间更长,住院时间延长(中位数53天对21天;68天对36天,均p < 0.05),以及额外手术操作的次数更多(p < 0.05)。产前肠壁增厚(大于或等于3 mm)的婴儿需要更长时间的肠外营养(中位数34天对20天;p < 0.01)和更长的住院时间(中位数44天对37天;p < 0.05)。羊水过少(羊水指数低于8 cm)与新生儿肠外营养使用时间更长相关(中位数30天对16天;p < 0.05)。

结论

羊水指数低于8 cm的单纯羊水过少、肠壁增厚等于或大于3 mm以及截断值为10 mm的产前腹腔内扩张对腹裂患者的不良产后结局具有显著预测价值。

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本文引用的文献

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Complex gastroschisis is a different entity to simple gastroschisis affecting morbidity and mortality-a systematic review and meta-analysis.复杂型腹裂与单纯型腹裂是不同的疾病实体,会影响发病率和死亡率——一项系统评价和荟萃分析
J Pediatr Surg. 2014 Oct;49(10):1527-32. doi: 10.1016/j.jpedsurg.2014.08.001. Epub 2014 Sep 4.
2
Is early delivery beneficial in gastroschisis?早产对腹裂有益吗?
J Pediatr Surg. 2014 Jun;49(6):928-33; discussion 933. doi: 10.1016/j.jpedsurg.2014.01.027.
3
Gastroschisis--what should be told to parents?腹裂——该告诉父母些什么?
肠脂肪酸结合蛋白作为腹裂肠损伤的标志物。
PLoS One. 2019 Jan 14;14(1):e0210797. doi: 10.1371/journal.pone.0210797. eCollection 2019.
4
Gastroschisis in monochorionic male twins.
Pediatr Surg Int. 2017 May;33(5):627-629. doi: 10.1007/s00383-017-4071-x. Epub 2017 Feb 17.
Prenat Diagn. 2014 Apr;34(4):316-26. doi: 10.1002/pd.4305. Epub 2014 Jan 20.
4
Gastroschisis and the risk of short bowel syndrome: outcomes and counselling.腹裂与短肠综合征风险:结局与咨询
Neonatology. 2014;105(1):5-8. doi: 10.1159/000351038. Epub 2013 Oct 31.
5
Expectant management compared with elective delivery at 37 weeks for gastroschisis.期待治疗与选择性 37 周剖宫产治疗先天性腹壁缺损的比较。
Obstet Gynecol. 2013 May;121(5):990-998. doi: 10.1097/AOG.0b013e31828ec299.
6
Can antenatal ultrasounds help predict postnatal outcomes in babies born with gastrochisis? The West Virginia experience.产前超声检查能否帮助预测患有腹裂的婴儿的产后结局?西弗吉尼亚州的经验。
W V Med J. 2013 Mar-Apr;109(2):22-7.
7
Postnatal outcome of fetuses with the prenatal diagnosis of gastroschisis.先天性腹裂胎儿的围生期结局。
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8
Gastroschisis with intestinal atresia--predictive value of antenatal diagnosis and outcome of postnatal treatment.先天性腹裂合并肠闭锁——产前诊断的预测价值及出生后治疗结果。
J Pediatr Surg. 2012 Feb;47(2):322-8. doi: 10.1016/j.jpedsurg.2011.11.022.
9
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