小儿（≤3 岁）腹部手术后黏连性小肠梗阻：采用多因素 COX 回归分析发病率及危险因素的回顾性分析。
Adhesive small bowel obstruction following abdominal surgery in young children (≤ 3 years): A retrospective analysis of incidence and risk factors using multivariate cox regression.
机构信息
Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Department of Paediatric Surgery, Meibergdreef 9, 1005 AZ, Amsterdam, Netherlands; Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Netherlands; Medical Library, Vrije Universiteit, Amsterdam, Netherlands.
Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Department of Paediatric Surgery, Meibergdreef 9, 1005 AZ, Amsterdam, Netherlands.
出版信息
J Pediatr Surg. 2022 Sep;57(9):55-60. doi: 10.1016/j.jpedsurg.2021.12.029. Epub 2022 Jan 21.
BACKGROUND
Adhesions following abdominal surgery can cause small bowel obstruction (SBO) necessitating surgery. Whilst some studies have addressed SBO in children, the incidence of SBO, the diseases that are of increased risk as well as risk factors in young children remain unclear. Therefore, this study aims to determine; (1) the general incidence of SBO in young children, (2) which diseases entail highest incidence of SBO and (3) risk factors for SBO in young children.
STUDY DESIGN
Young children (≤ 3 years of age) who underwent abdominal surgery in our tertiary referral centre between 1998-2018 were retrospectively included. Both general incidence and incidence per disease of SBO were determined. Independent risk factors for SBO were identified using cox-regression.
RESULTS
The incidence of SBO was 5% (N = 88/1931) in our cohort. Five of the SBOs developed following laparoscopic treatment. Patients treated for gastroschisis (17%,N = 9/53), necrotizing enterocolitis (8%,N = 15/188) and intestinal atresia (7%,N = 13/177) were at high risk of experiencing SBO. Diaphragmatic hernia (28%,N = 7/25) and meconium ileus (28%,N = 7/25) also showed high SBO proportions. Having a history of stoma (HR:3.2, 95%-CI:2.0-5.2), undergoing emergency surgery (HR:2.2, 95%-CI:1.3-3.7) and postoperative infections (HR:1.9, 95%-CI:1.2-3.1) were general risk factors for the development of SBO.
CONCLUSION
The incidence of SBO in young children seems higher than what has previously been reported in older children, which is why they should be studied separately. The incidence of SBO differs between diseases. Having a history of a stoma, emergency surgery and postoperative infections were independent risk factors for SBO development. Although less at risk, SBOs do develop after laparoscopies, which is why they should be included in more long-term follow-up studies.
LEVEL OF EVIDENCE
II.
背景
腹部手术后的粘连会导致小肠梗阻（SBO），需要手术治疗。虽然有些研究已经探讨了儿童的 SBO，但 SBO 的发生率、风险增加的疾病以及幼儿的危险因素仍不清楚。因此，本研究旨在确定：（1）幼儿 SBO 的总体发生率；（2）哪些疾病导致 SBO 发生率最高；（3）幼儿 SBO 的危险因素。
研究设计
回顾性纳入 1998 年至 2018 年期间在我们的三级转诊中心接受腹部手术的幼儿（≤ 3 岁）。确定 SBO 的总体发生率和每种疾病的发生率。使用 cox 回归确定 SBO 的独立危险因素。
结果
本队列中 SBO 的发生率为 5%（N=88/1931）。其中 5 例 SBO 发生在腹腔镜治疗后。患有先天性胃壁肌层缺损（17%，N=9/53）、坏死性小肠结肠炎（8%，N=15/188）和肠闭锁（7%，N=13/177）的患者发生 SBO 的风险较高。膈疝（28%，N=7/25）和胎粪性肠梗阻（28%，N=7/25）也显示出较高的 SBO 比例。有造口史（HR：3.2，95%-CI：2.0-5.2）、急诊手术（HR：2.2，95%-CI：1.3-3.7）和术后感染（HR：1.9，95%-CI：1.2-3.1）是 SBO 发展的一般危险因素。
结论
幼儿 SBO 的发生率似乎高于以往在较大儿童中报道的发生率，因此需要对其进行单独研究。SBO 的发生率因疾病而异。有造口史、急诊手术和术后感染是 SBO 发展的独立危险因素。尽管风险较低，但腹腔镜手术后确实会发生 SBO，因此应将其纳入更多的长期随访研究中。
证据水平
II。
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