Lauriti Giuseppe, Miscia Maria Enrica, Cascini Valentina, Chiesa Pierluigi Lelli, Pierro Agostino, Zani Augusto
Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatric Surgery, "Spirito Santo" Hospital, Pescara, and "G. d'Annunzio" University, Chieti-Pescara, Italy.
Department of Pediatric Surgery, "Spirito Santo" Hospital, Pescara, and "G. d'Annunzio" University, Chieti-Pescara, Italy.
J Pediatr Surg. 2019 Mar;54(3):378-382. doi: 10.1016/j.jpedsurg.2018.09.010. Epub 2018 Sep 29.
The management of intestinal malrotation in infants with omphalocele varies among surgeons. Herein, we aimed to determine whether infants with omphalocele should be investigated for malrotation.
Using a defined search strategy, three investigators identified all studies reporting patients with omphalocele and malrotation. Outcome measures included: 1. incidence of malrotation; 2. correlation with the abdominal size defect in patients with omphalocele; 3. risk of volvulus in those not investigated for malrotation; 4. incidence of adhesive bowel obstruction in those who underwent Ladd's procedure. The meta-analysis was conducted according to PRISMA guidelines and using RevMan 5.3.
Of 111 articles analyzed, 12 (3888 children) reported malrotation in 136 patients (3.5%). Malrotation was equally found in patients with major (15.2%) and minor (13.6%; p = 0.52) omphalocele. A volvulus was more common in children who had Ladd's procedure (8%) than in those who did not (1%; p = 0.03). Adhesive bowel obstruction rate was similar in both groups (5% vs. 3%; p = 0.21).
The incidence of malrotation in infants with omphalocele is low but probably underreported, and is not influenced by the size of the defect. At present, there is no evidence in the literature to support investigations to detect malrotation in infants with omphalocele.
Therapeutic.
III.
对于患有脐膨出的婴儿，外科医生对其肠旋转不良的处理方式各不相同。在此，我们旨在确定是否应对患有脐膨出的婴儿进行肠旋转不良的检查。
采用既定的检索策略，三名研究人员确定了所有报告患有脐膨出和肠旋转不良患者的研究。结果指标包括：1. 肠旋转不良的发生率；2. 脐膨出患者腹部缺损大小与之的相关性；3. 未接受肠旋转不良检查者发生肠扭转的风险；4. 接受Ladd手术者发生粘连性肠梗阻的发生率。根据PRISMA指南并使用RevMan 5.3进行荟萃分析。
在分析的111篇文章中，12篇（共3888名儿童）报告了136例患者（3.5%）存在肠旋转不良。在巨大脐膨出（15.2%）和小型脐膨出（13.6%；p = 0.52）患者中，肠旋转不良的发生率相当。接受Ladd手术的儿童（8%）比未接受该手术的儿童（1%）更易发生肠扭转（p = 0.03）。两组的粘连性肠梗阻发生率相似（5%对3%；p = 0.21）。
患有脐膨出的婴儿肠旋转不良的发生率较低，但可能存在报告不足的情况，且不受缺损大小的影响。目前，文献中没有证据支持对患有脐膨出的婴儿进行肠旋转不良检测的检查。
治疗性。
III级。
