Bhat Vishwanath, Moront Matthew, Bhandari Vineet
Division of Neonatology, Department of Pediatrics, The Children's Regional Hospital at Cooper, Cooper Medical School of Rowan University, One Cooper Plaza, Camden, NJ 08103, USA.
Division of Pediatric Surgery, Department of Pediatrics, The Children's Regional Hospital at Cooper, Cooper Medical School of Rowan University, One Cooper Plaza, Camden, NJ 08103, USA.
Children (Basel). 2020 Dec 17;7(12):302. doi: 10.3390/children7120302.
Gastroschisis, the most common type of abdominal wall defect, has seen a steady increase in its prevalence over the past several decades. It is identified, both prenatally and postnatally, by the location of the defect, most often to the right of a normally-inserted umbilical cord. It disproportionately affects young mothers, and appears to be associated with environmental factors. However, the contribution of genetic factors to the overall risk remains unknown. While approximately 10% of infants with gastroschisis have intestinal atresia, extraintestinal anomalies are rare. Prenatal ultrasound scans are useful for early diagnosis and identification of features that predict a high likelihood of associated bowel atresia. The timing and mode of delivery for mothers with fetuses with gastroschisis have been somewhat controversial, but there is no convincing evidence to support routine preterm delivery or elective cesarean section in the absence of obstetric indications. Postnatal surgical management is dictated by the condition of the bowel and the abdominal domain. The surgical options include either primary reduction and closure or staged reduction with placement of a silo followed by delayed closure. The overall prognosis for infants with gastroschisis, in terms of both survival as well as long-term outcomes, is excellent. However, the management and outcomes of a subset of infants with complex gastroschisis, especially those who develop short bowel syndrome (SBS), remains challenging. Future research should be directed towards identification of epidemiological factors contributing to its rising incidence, improvement in the management of SBS, and obstetric/fetal interventions to minimize intestinal damage.
腹裂是最常见的腹壁缺损类型，在过去几十年中其患病率稳步上升。通过缺损的位置，通常在正常插入的脐带右侧，在产前和产后均可识别腹裂。它对年轻母亲的影响尤为严重，并且似乎与环境因素有关。然而，遗传因素对总体风险的影响尚不清楚。虽然约10%的腹裂婴儿伴有肠道闭锁，但肠外畸形很少见。产前超声扫描有助于早期诊断和识别预测伴有肠道闭锁高可能性的特征。对于怀有腹裂胎儿的母亲，分娩时机和方式一直存在一定争议，但在没有产科指征的情况下，没有令人信服的证据支持常规早产或选择性剖宫产。产后手术管理取决于肠道状况和腹腔情况。手术选择包括一期复位和缝合或分期复位，放置一个肠袋，随后延迟缝合。就生存以及长期预后而言，腹裂婴儿的总体预后良好。然而，一部分复杂腹裂婴儿，尤其是那些发展为短肠综合征（SBS）的婴儿的管理和预后仍然具有挑战性。未来的研究应致力于确定导致其发病率上升的流行病学因素，改善SBS的管理，以及进行产科/胎儿干预以尽量减少肠道损伤。
