塞内加尔一家三级医疗中心胃肠道先天性畸形患者死亡相关因素
Factors associated with mortality in congenital malformations of the gastrointestinal tract in a tertiary center in Senegal.
作者信息
Zeng Florent Tshibwid A, Mbaye Papa Alassane, Gueye Doudou, Seck Ndèye Fatou, Wellé Ibrahima Bocar, Niang Rosalie, Diedhiou Youssouph, Fall Mbaye, Ndoye Ndèye Aby, Sagna Aloïse, Ndour Oumar, Ngom Gabriel
机构信息
Department of Pediatric Surgery, Albert Royer National Children's Hospital Center, Université Cheikh Anta Diop Faculté de Medecine Pharmacie d'Odonto-Stomatologie, Dakar, Senegal.
Department of Pediatric Surgery, Aristide Le Dantec University Teaching Hospital, Université Cheikh Anta Diop Faculté de Medecine Pharmacie d'Odonto-Stomatologie, Dakar, Senegal.
出版信息
World J Pediatr Surg. 2023 Jan 19;6(1):e000463. doi: 10.1136/wjps-2022-000463. eCollection 2022.
OBJECTIVE
Patients with congenital malformations (CMs) of the gastrointestinal tract (GIT) have a very high mortality. However, the literature on the factors associated with mortality in these patients is scarce in sub-Saharan Africa. The aim of this study is to identify independent risk factors for mortality in patients with CMs of the GIT at our pediatric surgical department.
METHODS
We conducted a retrospective analysis of cases with CMs of the GIT managed at a tertiary center from 2018 to 2021. Patients were subdivided into two groups based on the outcomes, and variables with a significant difference were analyzed by logistic regression.
RESULTS
Our review included 226 patients, 63 of whom died (27.88%). Patient age ranged from 0 to 15 years. Taking into account statistical significance, mortality was more frequent in neonates than in older patients (57.30% vs 6.15%), in patients coming out of the Dakar area than in those from the Dakar area (43.75% vs 19.18%), in patients with abnormal prenatal ultrasound than in those with normal ultrasound (100% vs 26.67%), in premature children than in those born at term (78.57% vs 21.87%), in patients with an additional malformation than in those with an isolated malformation (69.23% vs 25.35%), and in those with intestinal, esophageal, duodenal and colonic atresia than in those with other diagnoses (100%, 89%, 56.25% and 50%, respectively). Referred patients died more than those who changed hospitals or came from home (55.29% vs 25% and 9.09%, respectively). On multivariable logistic regression, two independent factors of mortality were identified: presence of associated malformation [odds ratio (OR)=13.299; 95% Confidence interval (CI) 1.370 to 129.137] and diagnosis of esophageal atresia (OR=46.529; 95% CI 5.828 to 371.425).
CONCLUSION
The presence of an associated malformation or diagnosis of esophageal atresia increases mortality in patients with CMs of the GIT in our environment.
目的
胃肠道先天性畸形（CMs）患者的死亡率非常高。然而，在撒哈拉以南非洲地区，关于这些患者死亡率相关因素的文献却很匮乏。本研究的目的是确定我们儿科外科部门中胃肠道先天性畸形患者死亡的独立危险因素。
方法
我们对2018年至2021年在一家三级中心接受治疗的胃肠道先天性畸形病例进行了回顾性分析。根据结果将患者分为两组，并通过逻辑回归分析有显著差异的变量。
结果
我们的回顾纳入了226例患者，其中63例死亡（27.88%）。患者年龄在0至15岁之间。考虑到统计学意义，新生儿的死亡率高于年龄较大的患者（57.30%对6.15%），来自达喀尔地区以外的患者高于来自达喀尔地区的患者（43.75%对19.18%），产前超声异常的患者高于超声正常的患者（100%对26.67%），早产儿高于足月儿（78.57%对21.87%），合并其他畸形的患者高于单纯畸形的患者（69.23%对25.35%），以及患有肠道、食管、十二指肠和结肠闭锁的患者高于其他诊断的患者（分别为100%、89%、56.25%和50%）。转诊患者的死亡率高于转院或来自家中的患者（分别为55.29%对25%和9.09%）。在多变量逻辑回归分析中，确定了两个死亡的独立因素：合并畸形的存在[比值比（OR）=13.299；95%置信区间（CI）1.370至129.137]和食管闭锁的诊断（OR=46.529；95%CI 5.828至371.425）。
结论
在我们的环境中，合并畸形的存在或食管闭锁的诊断会增加胃肠道先天性畸形患者的死亡率。
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