Pet Gillian E, Stark Rebecca A, Meehan John J, Javid Patrick J
Department of Pediatrics, University of Washington, School of Medicine, Seattle Children's Hospital, Seattle, WA, USA.
Department of Surgery, University of California-Davis, Davis, CA, USA.
Am J Surg. 2017 May;213(5):958-962. doi: 10.1016/j.amjsurg.2017.03.017. Epub 2017 Mar 24.
Newborns with gastroschisis have historically undergone surgical repair under general anesthesia. Our institution recently transitioned to the sutureless umbilical closure for gastroschisis. We sought to evaluate the feasibility of bedside gastroschisis repair without endotracheal intubation.
A retrospective review was performed of neonates with gastroschisis who underwent sutureless umbilical closure from 2011 to 2015. Clinical characteristics and outcomes between groups were compared.
In total, 53 infants underwent sutureless umbilical closure. Closure without endotracheal intubation was attempted in 23 (43%) babies and was successful in 15 (65%) infants. Two of the 8 patients who required intubation needed a temporary silo. Neonates successfully repaired without intubation were more premature (p < 0.01), smaller at birth (p = 0.01), and repaired nearly an hour sooner (p < 0.01). There were no differences in time to full enteral nutrition, length of stay, bowel ischemia, or sepsis.
Bedside sutureless umbilical closure without intubation is feasible and effective in newborns with gastroschisis. The procedure decreases time to gastroschisis closure. Smaller and more premature neonates were more likely to be successfully closed without intubation.
历史上，患有腹裂的新生儿在全身麻醉下接受手术修复。我们机构最近转而采用无缝合脐部闭合术治疗腹裂。我们试图评估在不进行气管插管的情况下床边修复腹裂的可行性。
对2011年至2015年接受无缝合脐部闭合术的腹裂新生儿进行回顾性研究。比较两组之间的临床特征和结果。
共有53例婴儿接受了无缝合脐部闭合术。23例（43%）婴儿尝试了不进行气管插管的闭合术，其中15例（65%）成功。8例需要插管的患者中有2例需要临时放置肠袋。未插管成功修复的新生儿早产程度更高（p < 0.01），出生时体重更小（p = 0.01），修复时间提前近一小时（p < 0.01）。在完全肠内营养时间、住院时间、肠缺血或败血症方面没有差异。
对于患有腹裂的新生儿，不插管的床边无缝合脐部闭合术是可行且有效的。该手术缩短了腹裂闭合时间。更小和更早产的新生儿更有可能在不插管的情况下成功闭合。
