Department of Surgery, Division of Pediatric Surgery, University Ulm Medical Centre, Eythstrasse, Ulm, Germany.
Department of Gynaecology and Obstetrics, Hospital Heidenheim, Heidenheim an der Brenz, Germany.
Afr J Paediatr Surg. 2022 Jan-Mar;19(1):46-51. doi: 10.4103/ajps.AJPS_8_20.
Gastroschisis (GS) and omphalocele (OC) are congenital abdominal wall defects, the main difference between is the direct exposure of intestinal loops in amniotic fluid in children with a GS. This leads to a reduced primary closure rate and a higher number of intraoperative abnormalities and post-operative complications.
We analysed abdominal wall defect patients over an 11-year period, aiming to assess the influence of meconium-contaminated amniotic fluid. This study has different objectives to show the consequence of functional outcome of abdominal wall defects (AWD) children in reliance to colour of amniotic fluid, to assess the effect of reduced bowel exposure time to meconium contaminated amniotic fluid on edematous inflammatory thickening of the bowel loops, to show an positively influence in the number of primary AWD closures, to demonstrate a reduced incidence of post-natal complications and to verify a better outcome of OC children because of failing exposure to amniotic fluid.
A retrospective, observational case-control design was used to compare GS (n = 36) and OC (n = 18) children. Physical data, colour of amniotic fluid, pre- and perinatal problems, operative complications and surgical technique, post-operative complications, duration of intensive care unit (ICU) stay, mechanical ventilation, parenteral nutrition, commencement of oral feeding and total hospital stay were collected. Data were analysed with descriptive methods, t-test and non-parametric tests such as Wilcoxon and Kruskal-Wallis were performed in addition to the analysis of variance, including post hoc testing accepting a confidence interval of 95% (P < 0.05) by using IBM SPSS software, version 23 (IBM, Illinois, USA).
Rate of meconium-contaminated amniotic fluid is significantly higher in GS compared to OC (P < 0.001), delivery problems such as congenital infections are also significantly higher (P < 0.001), this yields in significantly more bowel loops anomalies and problems during surgery (P < 0.036) but had no significant influence on primary abdominal wall closures rate (P = 0.523). The post-surgical outcome of OC was significantly better as compared to GS. Within the GS, those with swollen intestines had significantly longer ICU stays (P = 0.045) due to extended mechanical ventilation (P = 0.007), parenteral nutrition (P = 0.011) and delayed initiation of oral feeding (P < 0.001. Same results were found for the duration of ICU stay (P = 0.008), mechanical ventilation (P = 0.006), parenteral nutrition (P = 0.011) and delayed initiation of oral feeding (P < 0.001) in secondary closures as compared to primary abdominal wall closures in the GS group.
Worsen functional short-term outcome of GS children was directly addicted to meconium contamination of amniotic fluid due to swollen intestines and because of this more post-surgical problem including significantly extended hospital stays were observed.
先天性腹壁缺陷包括腹裂（GS）和脐膨出（OC），两者的主要区别在于 GS 患儿的肠袢直接暴露在羊水中。这导致一期关闭率降低，术中异常和术后并发症增多。
我们分析了 11 年间的腹壁缺陷患者，旨在评估胎粪污染羊水的影响。本研究的目的不同，旨在展示腹壁缺陷（AWD）患儿的功能结局与羊水颜色的关系，评估减少肠袢暴露于胎粪污染羊水的时间对肠袢水肿性炎症性增厚的影响，显示一期 AWD 关闭率的增加，显示产后并发症发生率的降低，并验证 OC 患儿因羊水暴露失败而导致的更好结局。
采用回顾性、观察性病例对照设计，比较 GS（n=36）和 OC（n=18）患儿。收集体格数据、羊水颜色、围产期问题、手术并发症和手术技术、术后并发症、重症监护病房（ICU）停留时间、机械通气、肠外营养、开始口服喂养和总住院时间。采用描述性方法、t 检验和非参数检验（如 Wilcoxon 和 Kruskal-Wallis 检验）进行数据分析，并进行方差分析，包括事后检验，置信区间为 95%（P<0.05），采用 IBM SPSS 软件，版本 23（IBM，伊利诺伊州，美国）。
GS 胎粪污染羊水的发生率明显高于 OC（P<0.001），先天性感染等分娩问题也明显更高（P<0.001），这导致肠袢异常和手术问题明显增加（P<0.036），但对一期腹壁关闭率无显著影响（P=0.523）。OC 的术后转归明显优于 GS。在 GS 中，由于肿胀的肠道，那些需要机械通气（P=0.007）、肠外营养（P=0.011）和延迟开始口服喂养（P<0.001）的患儿 ICU 停留时间明显延长。同样的结果也见于 GS 中二期关闭与一期腹壁关闭相比，ICU 停留时间（P=0.008）、机械通气（P=0.006）、肠外营养（P=0.011）和延迟开始口服喂养（P<0.001）。
GS 患儿的短期功能结局恶化与羊水胎粪污染直接相关，由于肠袢肿胀，观察到更多的术后问题，包括显著延长的住院时间。
