Mutanen Annika, Koivusalo Antti, Pakarinen Mikko
Section of Pediatric Surgery, University of Helsinki, Helsinki University Central Hospital, Children's Hospital, Helsinki, Finland.
Eur J Pediatr Surg. 2018 Dec;28(6):495-501. doi: 10.1055/s-0037-1607198. Epub 2017 Oct 4.
The study aimed to compare outcomes and intestinal morbidity among complicated gastroschisis, isolated gastroschisis, and intestinal atresia.
In this retrospective observational single institution study, outcomes and intestinal morbidity were compared among gastroschisis complicated by intestinal atresia or perinatal bowel perforation, isolated gastroschisis, and isolated intestinal atresia. We included two cohorts; the first cohort included 68 consecutive patients with complicated gastroschisis ( = 9), isolated gastroschisis ( = 34), and intestinal atresia ( = 25) managed in our center. The second cohort included 20 patients (12 referred) with intestinal failure due to these underlying etiologies managed by our intestinal rehabilitation team.
Patients with complicated gastroschisis had a significantly longer need for mechanical ventilation, primary hospital stay, and duration of parenteral nutrition (PN) and developed intestinal failure more often compared with other groups ( < 0.05 for all). Reoperations for surgical complications were also more frequent in patients with complicated gastroschisis ( < 0.05). Among those, who developed intestinal failure, autologous intestinal reconstruction (AIR) surgery was performed in 11 patients with comparable frequency in all groups. Repeated AIR surgery for bowel re-dilatation was required in 3/3 patients with complicated gastroschisis and 0/8 with isolated gastroschisis or intestinal atresia ( = 0.004).
Complicated gastroschisis is associated with markedly increased intestinal morbidity, reflected by prolonged duration of PN, more frequent reoperations for intestinal complications, and bowel re-dilatation after AIR surgery, when compared with patients with isolated gastroschisis or intestinal atresia.
本研究旨在比较复杂型腹裂、单纯型腹裂和肠闭锁患者的治疗结局及肠道发病率。
在这项单机构回顾性观察研究中，对合并肠闭锁或围产期肠穿孔的腹裂、单纯型腹裂和单纯型肠闭锁患者的治疗结局及肠道发病率进行了比较。我们纳入了两个队列；第一个队列包括在我们中心接受治疗的68例连续患者，其中复杂型腹裂9例、单纯型腹裂34例和肠闭锁25例。第二个队列包括由我们的肠道康复团队治疗的20例因这些潜在病因导致肠衰竭的患者（其中12例为转诊患者）。
与其他组相比，复杂型腹裂患者机械通气需求时间、初次住院时间和肠外营养（PN）持续时间显著更长，且更常发生肠衰竭（所有P均<0.05）。复杂型腹裂患者因手术并发症进行再次手术的频率也更高（P<0.05）。在发生肠衰竭的患者中，11例患者接受了自体肠道重建（AIR）手术，所有组的频率相当。3例复杂型腹裂患者中有3例需要因肠管再次扩张而重复进行AIR手术，而8例单纯型腹裂或肠闭锁患者中无一例需要（P=0.004）。
与单纯型腹裂或肠闭锁患者相比，复杂型腹裂患者的肠道发病率显著增加，表现为PN持续时间延长、因肠道并发症进行再次手术的频率更高以及AIR手术后肠管再次扩张。
