Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea.
Department of Pediatric Surgery, Seoul National University, College of Medicine, Seoul, Korea.
Sci Rep. 2018 Oct 24;8(1):15681. doi: 10.1038/s41598-018-33351-9.
There are few reports on enterostomy closure (EC) timing for acute abdomen in extremely low birth weight (ELBW) patients. We retrospectively reviewed ELBW patients who underwent enterostomy formation (EF) and subsequent EC. We investigated baseline characteristics, surgical outcomes, and follow-up data of 55 patients and analyzed optimal timing by age at EC, enterostomy duration, and body weight (Bwt) at EC. The minimum p-value approach (MPA) using the Chi-squared test was used to determine each cut-off value. Mean gestational age was 25 weeks, while mean age and Bwt at EF were 10 days and 660 g. Enterostomy duration and Bwt at EC were 102 days and 2400 g. Fourteen surgical complications were related to EC. The MPA identified a cut-off of 2100 g (p = 0.039) at EC but no significant cut-off age or enterostomy duration. The 18 patients <2100 g had more enterostomy-related problems at EC than the >2100 g group (66.7% vs 10.8%, p < 0.001). No other characteristics were significantly different. Operation time, ventilator period, hospital stay, parenteral nutrition duration, and full feeding day were significantly longer in <2100 g patients. Follow-up Bwt did not differ (11.55 kg vs 13.95 kg, p = 0.324). Our findings suggest EC can be safely performed when Bwt is over 2100 g.
对于极低出生体重（ELBW）患儿的急性腹部问题，行肠造口关闭（EC）的时机鲜有报道。我们回顾性分析了行肠造口形成（EF）并随后行 EC 的 ELBW 患儿。我们调查了 55 例患儿的基线特征、手术结果和随访数据，并通过 EC 时的年龄、肠造口持续时间和 EC 时的体重（Bwt）分析最佳时机。采用卡方检验的最小 P 值法（MPA）确定每个截断值。平均胎龄为 25 周，EF 时的平均年龄和 Bwt 分别为 10 天和 660g。肠造口持续时间和 EC 时的 Bwt 分别为 102 天和 2400g。14 例手术并发症与 EC 相关。MPA 确定了 EC 时的截断值为 2100g（p=0.039），但无显著的截断年龄或肠造口持续时间。18 例 <2100g 患儿在 EC 时肠造口相关问题多于>2100g 患儿（66.7%比 10.8%，p<0.001）。其他特征无显著差异。<2100g 患儿的手术时间、呼吸机使用时间、住院时间、肠外营养时间和完全喂养天数显著更长。随访时的 Bwt 无差异（11.55kg 比 13.95kg，p=0.324）。我们的研究结果表明，当 Bwt 超过 2100g 时，EC 可以安全进行。
