Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, and Vrije Universiteit Amsterdam, Meibergdreef 9, 1005 AZ Amsterdam, the Netherlands; Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, and Vrije Universiteit Amsterdam, Meibergdreef 9, 1005 AZ Amsterdam, the Netherlands.
J Pediatr Surg. 2021 Sep;56(9):1547-1554. doi: 10.1016/j.jpedsurg.2021.01.018. Epub 2021 Jan 17.
Surgical site infections (SSI) are a frequent and significant problem understudied in infants operated for abdominal birth defects. Different forms of SSIs exist, namely wound infection, wound dehiscence, anastomotic leakage, post-operative peritonitis and fistula development. These complications can extend hospital stay, surge medical costs and increase mortality. If the incidence was known, it would provide context for clinical decision making and aid future research. Therefore, this review aims to aggregate the available literature on the incidence of different SSIs forms in infants who needed surgery for abdominal birth defects.
The electronic databases Pubmed, EMBASE, and Cochrane library were searched in February 2020. Studies describing infectious complications in infants (under three years of age) were considered eligible. Primary outcome was the incidence of SSIs in infants. SSIs were categorized in wound infection, wound dehiscence, anastomotic leakage, postoperative peritonitis, and fistula development. Secondary outcome was the incidence of different forms of SSIs depending on the type of birth defect. Meta-analysis was performed pooling reported incidences in total and per birth defect separately.
154 studies, representing 11,786 patients were included. The overall pooled percentage of wound infections after abdominal birth defect surgery was 6% (95%-CI:0.05-0.07) ranging from 1% (95% CI:0.00-0.05) for choledochal cyst surgery to 10% (95%-CI:0.06-0.15) after gastroschisis surgery. Wound dehiscence occurred in 4% (95%-CI:0.03-0.07) of the infants, ranging from 1% (95%-CI:0.00-0.03) after surgery for duodenal obstruction to 6% (95%-CI:0.04-0.08) after surgery for gastroschisis. Anastomotic leakage had an overall pooled percentage of 3% (95%-CI:0.02-0.05), ranging from 1% (95%-CI:0.00-0.04) after surgery for duodenal obstruction to 14% (95% CI:0.06-0.27) after colon atresia surgery. Postoperative peritonitis and fistula development could not be specified per birth defect and had an overall pooled percentage of 3% (95%-CI:0.01-0.09) and 2% (95%-CI:0.01-0.04).
This review has systematically shown that SSIs are common after correction for abdominal birth defects and that the distribution of SSI differs between birth defects.
手术部位感染（SSI）是在腹部出生缺陷患儿中进行手术时经常发生且未得到充分研究的一个严重问题。存在不同形式的 SSI，即伤口感染、伤口裂开、吻合口漏、术后腹膜炎和瘘管形成。这些并发症会延长住院时间、增加医疗费用并增加死亡率。如果知道其发生率，将为临床决策提供依据，并有助于未来的研究。因此，本综述旨在汇总有关需要手术治疗腹部出生缺陷的婴儿中不同形式 SSI 发生率的现有文献。
2020 年 2 月，检索电子数据库 Pubmed、EMBASE 和 Cochrane library。将描述婴儿（三岁以下）感染并发症的研究纳入标准。主要结局是婴儿 SSI 的发生率。SSI 分为伤口感染、伤口裂开、吻合口漏、术后腹膜炎和瘘管形成。次要结局是根据出生缺陷的类型，不同形式 SSI 的发生率。对报告的发生率进行汇总分析，总发生率和每种出生缺陷的发生率分别进行汇总。
共纳入 154 项研究，代表 11786 例患者。腹部出生缺陷手术后伤口感染的总体合并百分比为 6%（95%CI：0.05-0.07），范围为胆总管囊肿手术的 1%（95%CI：0.00-0.05）至先天性脐膨出手术的 10%（95%CI：0.06-0.15）。婴儿中有 4%（95%CI：0.03-0.07）发生伤口裂开，其中十二指肠梗阻手术为 1%（95%CI：0.00-0.03），先天性脐膨出手术为 6%（95%CI：0.04-0.08）。吻合口漏的总体合并百分比为 3%（95%CI：0.02-0.05），范围为十二指肠梗阻手术的 1%（95%CI：0.00-0.04）至结肠闭锁手术的 14%（95%CI：0.06-0.27）。术后腹膜炎和瘘管形成无法按出生缺陷分类，总体合并百分比分别为 3%（95%CI：0.01-0.09）和 2%（95%CI：0.01-0.04）。
本综述系统地表明，腹部出生缺陷矫正术后 SSI 很常见，且 SSI 的分布因出生缺陷而异。
Zotero 插件