Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
Lancet. 2017 Sep 9;390(10099):1072-1082. doi: 10.1016/S0140-6736(17)32284-5.
Recent developments in paediatric gastrointestinal surgery have focused on minimally invasive surgery, the accumulation of high-quality clinical evidence, and scientific research. The benefits of minimally invasive surgery for common disorders like appendicitis and hypertrophic pyloric stenosis are all supported by good clinical evidence. Although minimally invasive surgery has been extended to neonatal surgery, it is difficult to establish its role for neonatal disorders such as oesophageal atresia and biliary atresia through clinical trials because of the rarity of these disorders. Advances in treatments for biliary atresia and necrotising enterocolitis have been achieved through specialisation, multidisciplinary management, and multicentre collaboration in research; similarly robust clinical evidence for other rare gastrointestinal disorders is needed. As more neonates with gastrointestinal diseases survive into adulthood, their long-term sequelae will also need evidence-based multidisciplinary care. Identifying cures for long-term problems of a complex developmental anomaly such as Hirschsprung's disease will rely on unravelling its pathogenesis through genetics and the development of stem-cell therapy.
小儿胃肠外科学的最新进展集中在微创手术、高质量临床证据的积累和科学研究上。微创手术治疗阑尾炎和肥厚性幽门狭窄等常见疾病的益处都有良好的临床证据支持。尽管微创手术已扩展到新生儿外科,但由于这些疾病的罕见性,通过临床试验很难为食管闭锁和胆道闭锁等新生儿疾病确定其作用。胆道闭锁和坏死性小肠结肠炎治疗的进展是通过专业化、多学科管理和研究中的多中心合作实现的;同样,其他罕见胃肠道疾病也需要强有力的临床证据。随着越来越多患有胃肠道疾病的新生儿存活到成年,他们的长期后遗症也需要循证多学科护理。通过遗传学和干细胞治疗来阐明先天性巨结肠等复杂发育异常的发病机制,将有助于找到治疗其长期问题的方法。