Section of Pediatric Surgery, Yale University School of Medicine/Yale-New haven Hospital, New Haven, CT.
Section of Pediatric Surgery, Saint Louis University/Cardinal Glennon Children's Medical Center, St. Louis, MO; Saint Louis University School of Medicine, Saint Louis, MO.
J Pediatr Surg. 2020 Jul;55(7):1270-1275. doi: 10.1016/j.jpedsurg.2019.07.007. Epub 2019 Jul 19.
The purpose of our study was to compare outcomes of infants with spontaneous intestinal perforation (SIP) treated with primary peritoneal drain versus primary laparotomy.
We performed a multi-institution retrospective review of infants with diagnosis of SIP from 2012 to 2016. Clinical characteristics and outcomes were compared between infants treated with primary peritoneal drain vs infants treated with laparotomy.
We identified 171 patients treated for SIP (drain n = 110 vs. laparotomy n = 61). There were no differences in maternal or prenatal characteristics. There were no clinically significant differences in vital signs, white blood cell or platelet measures, up to 48 h after intervention. Patients who were treated primarily with a drain were more premature (24.9 vs. 27.2 weeks, p < 0.001) and had lower median birth weight (710 g vs. 896 g, p < 0.001). No significant differences were found in complications, time to full feeds, length of stay (LOS) or mortality between the groups. Primary laparotomy group had more procedures (median number 1 vs. 2, p = 0.002). There were 32 (29%) primary drain failures whereby a laparotomy was ultimately needed.
SIP treated with primary drain is successful in the majority of patients with no significant differences in outcomes when compared to laparotomy with stoma.
III.
本研究旨在比较采用单纯腹腔引流与剖腹术治疗自发性肠穿孔（SIP）患儿的结局。
我们对 2012 年至 2016 年期间诊断为 SIP 的婴儿进行了多机构回顾性研究。比较了采用单纯腹腔引流与剖腹术治疗的婴儿的临床特征和结局。
我们共纳入 171 例接受 SIP 治疗的患儿（引流组 n=110 例，剖腹术组 n=61 例）。两组患儿的母亲或产前特征无差异。干预后 48 小时内，两组患儿的生命体征、白细胞或血小板指标均无明显差异。采用单纯引流治疗的患儿更早产（24.9 周 vs. 27.2 周，p<0.001），出生体重中位数更低（710g vs. 896g，p<0.001）。两组患儿的并发症、完全经口喂养时间、住院时间（LOS）或死亡率无显著差异。剖腹术组的手术次数更多（中位数 1 次 vs. 2 次，p=0.002）。有 32 例（29%）患儿引流失败，最终需要剖腹术。
对于 SIP，采用单纯引流治疗在大多数患者中是成功的，与造口术相比，其结局无显著差异。
III。
