Escarcega-Fujigaki Pastor, Hernandez-Peredo-Rezk Guillermo, Wright Naomi J, Del Carmen Cardenas-Paniagua Ahtziri, Velez-Blanco Haydee, Gutierrez-Canencia Celine, Saavedra-Velez Lorenzo, Venegas-Espinoza Berenice, Diaz-Luna Jose Luis, Castro-Ramirez Miguel
Department of Pediatric Surgery, Centro de Alta Especialidad Dr. Rafael Lucio, Av Adolfo Ruiz Rortines 2903, col. Unidad Magisterial, Xalapa, Veracruz, Mexico.
King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, London, UK.
World J Surg. 2022 Feb;46(2):322-329. doi: 10.1007/s00268-021-06357-0. Epub 2021 Oct 21.
This research adopted a care protocol from high-income countries in a level II/III hospital in a middle-income country to decrease morbidity and mortality associated with gastroschisis.
We established a multidisciplinary protocol to treat patients with gastroschisis prospectively from November 2012 to November 2018. This included prenatal diagnosis, presence of a neonatologist and pediatric surgeon at birth, and either performing primary closure on the patients with an Apgar score of 8/9, mild serositis, and no breathing difficulty or placing a preformed silo, when unable to fulfill these criteria, under sedation and analgesia (no intubation) in the operating room or at the patients' bedside. The subsequent management took place in the neonatal intensive care unit. The data were analyzed through the Mann-Whitney and Student's t-distribution for the two independent samples; the categorical variables were analyzed through a chi-square distribution or Fisher's exact test.
In total, 55 patients were included in the study: 33 patients (60%) were managed with a preformed silo, whereas 22 patients (40%) underwent primary closure. Prenatal diagnosis (P = 0.02), birth at the main hospital (P = 0.02), and the presence of a pediatric surgeon at birth (P = 0.04) were associated with successful primary closure. The primary closure group had fewer fasting days (P < 0.001) and a shorter neonatal intensive care unit length of stay (P = 0.025). The survival rate was 92.7% (51 patients).
The treatment model modified to fit the means of our hospital proved successful.
本研究在一个中等收入国家的一家二级/三级医院采用了高收入国家的护理方案，以降低与腹裂相关的发病率和死亡率。
我们建立了一个多学科方案，对2012年11月至2018年11月期间的腹裂患者进行前瞻性治疗。这包括产前诊断、出生时配备新生儿科医生和小儿外科医生，以及对阿氏评分8/9、轻度浆膜炎且无呼吸困难的患者进行一期缝合，或在无法满足这些标准时，在手术室或患者床边进行镇静和镇痛（不插管）的情况下放置预制袋。随后的管理在新生儿重症监护病房进行。对两个独立样本的数据通过曼-惠特尼检验和学生t分布进行分析；分类变量通过卡方分布或费舍尔精确检验进行分析。
本研究共纳入55例患者：33例患者（60%）采用预制袋治疗，而22例患者（40%）接受一期缝合。产前诊断（P = 0.02）、在主要医院出生（P = 0.02）以及出生时存在小儿外科医生（P = 0.04）与成功进行一期缝合相关。一期缝合组的禁食天数较少（P < 0.001），新生儿重症监护病房住院时间较短（P = 0.025）。生存率为92.7%（51例患者）。
经修改以适应我院条件的治疗模式被证明是成功的。
