Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
Department of Paediatric Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
Eur J Pediatr Surg. 2021 Oct;31(5):407-413. doi: 10.1055/s-0040-1714714. Epub 2020 Aug 26.
Understanding the challenges experienced by pediatric surgeons in the early phases of the pandemic may help identify key issues and focus research.
Two pediatric surgeons from each of the 10 countries most affected by COVID-19 were surveyed over a 10-day period. Data were obtained regarding service provision, infection control, specific surgical conditions, and the surgical workforce.
Twenty pediatric surgeons responded. All centers had postponed non-emergency surgery and clinics for nonurgent conditions with virtual consultations being undertaken in 90% of centers. A majority (65%) of centers had not yet knowingly operated on a positive patient. Minimal access surgery was performed in 75% centers but a further 75% had reduced or stopped upper gastrointestinal endoscopy. The management of simple appendicitis was unchanged in 70% centers, patients with intussusception were being referred for radiological reduction in all centers and definitive pull-through surgery for Hirschsprung patients was performed by 95% where washouts were successful. Timing of surgery for reducible neonatal inguinal hernias had changed in 55% of centers and the management of urgent feeding gastrostomy referrals and of inflammatory bowel disease patients failing with biological therapy varied considerably.
Service provision has been severely affected by COVID-19 leading to an inevitable increase in untreated surgical pathology. Better understanding of extrapulmonary infectivity, the risk of asymptomatic carriage in children, and the reliability of testing for surgical scenarios may allow appropriate use of conventional surgery, including laparoscopy and endoscopy, and rational development of the novel care pathways needed during the pandemic.
了解儿科外科医生在疫情早期所面临的挑战，有助于确定关键问题并聚焦研究。
对 COVID-19 感染最严重的 10 个国家中的每个国家的 2 名儿科外科医生进行了为期 10 天的调查。收集了有关服务提供、感染控制、特定手术情况和外科工作人员的数据。
20 名儿科外科医生做出回应。所有中心均已推迟非紧急手术和非紧急情况下的门诊，90%的中心均进行了虚拟咨询。大多数中心（65%）尚未在知情的情况下为阳性患者进行手术。75%的中心开展了微创外科手术，但另有 75%的中心减少或停止了上消化道内镜检查。70%的中心对单纯阑尾炎的处理方式未改变，所有中心均将肠套叠患者转介进行放射复位，95%的先天性巨结肠患儿在冲洗成功后进行根治性拖出手术。55%的中心改变了可复性新生儿腹股沟疝的手术时机，紧急肠内营养造口术和对生物治疗失败的炎症性肠病患者的处理方式差异很大。
COVID-19 严重影响了服务提供，导致无法避免的未治疗手术病理增加。更好地了解肺外传染性、儿童无症状携带的风险以及针对手术情况的检测可靠性，可能有助于合理使用传统手术（包括腹腔镜和内镜），并在疫情期间合理制定新的护理途径。
