Dübbers Martin, Holtkamp Gerd, Cernaianu Grigore, Bludau Marc, Fischer Janina, Keller Titus, Kribs Angela, Schulten Daisy
Division of Pediatric Surgery, Medical Faculty and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
Department of General, Visceral and Cancer Surgery, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany.
Eur J Pediatr. 2021 May;180(5):1529-1535. doi: 10.1007/s00431-021-03926-2. Epub 2021 Jan 12.
The aim was to assess the results of primary anastomosis (PA) compared to enterostomy (ES) in infants with spontaneous intestinal perforation (SIP) and a weight below 1000 g. Between 2014 and 2016, enterostomy was routinely carried out on extremely low birth weight (ELBW) patients with SIP. From 2016 until 2019, all patients underwent anastomosis without stoma formation. We compared outcome and complications in both groups. Forty-two patients with a median gestational age of 24.3 weeks and a birth weight of 640 g with SIP were included. Thirty patients underwent PA; ES was performed in 12 patients. Overall in-hospital mortality was 11.9% (PA: 13.3%, ES: 8.3%). Reoperations due to complications became necessary in 10/30 patients with PA and 4/12 patients with ES. Length of stay was 110.5 days in the PA group and 124 days in the ES group. Median weight at discharge was higher in the PA group (PA: 2258 g, ES: 1880 g, p = .036).Conclusion: Primary anastomosis is a feasible treatment option for SIP in infants < 1000 g and may have a positive impact on weight gain and length of hospitalization. However, further studies on selection criteria for PA are necessary. What is Known: • Enterostomy (ES) and primary anastomosis (PA) are feasible treatment options in preterm infants with spontaneous intestinal perforation (SIP). • Stomal complications or failure to thrive due to poor food utilization can pose significant problems. What is New: • Primary anastomosis in case of SIP is equal to enterostomy in terms of mortality and revision rate; however, length of stay and weight gain can be presumably positively influenced. • Primary anastomosis is a valid treatment option even for patients weighing less than 1000 g.
本研究旨在评估在体重低于1000克的自发性肠穿孔（SIP）婴儿中，一期吻合术（PA）与肠造口术（ES）的治疗效果。2014年至2016年期间，对于患有SIP的极低出生体重（ELBW）患者常规施行肠造口术。2016年至2019年期间，所有患者均接受了无造口形成的吻合术。我们比较了两组患者的治疗结果和并发症情况。纳入了42例患有SIP、中位胎龄为24.3周、出生体重为640克的患者。30例患者接受了PA；12例患者接受了ES。总体住院死亡率为11.9%（PA组：13.3%，ES组：8.3%）。PA组30例患者中有10例因并发症需要再次手术，ES组12例患者中有4例需要再次手术。PA组的住院时间为110.5天，ES组为124天。PA组出院时的中位体重更高（PA组：2258克，ES组：1880克，p = 0.036）。结论：一期吻合术是体重＜1000克的SIP婴儿的一种可行治疗选择，可能对体重增加和住院时间产生积极影响。然而，有必要对PA的选择标准进行进一步研究。已知信息：• 肠造口术（ES）和一期吻合术（PA）是早产自发性肠穿孔（SIP）婴儿的可行治疗选择。• 造口并发症或因食物利用不良导致的发育不良可能会带来重大问题。新发现：• SIP患者的一期吻合术在死亡率和翻修率方面与肠造口术相当；然而，住院时间和体重增加可能会受到积极影响。• 一期吻合术即使对于体重小于1000克的患者也是一种有效的治疗选择。
