Section of Pediatric Surgery, University of Michigan, 1540 E. Hospital Drive, Floor 4 Reception B, Ann Arbor, MI, 48109, USA.
Department of Surgery, Maine Medical Center, 22 Bramhall St, Portland, ME, USA.
Pediatr Surg Int. 2023 Mar 1;39(1):143. doi: 10.1007/s00383-023-05430-0.
Neonatal abdominal reoperation is difficult and can be complicated by abdominal adhesions. Identifying patients who could safely undergo early reoperation would save TPN and central line days, decrease associated infection and liver injury, and NICU and hospital length of stay. We sought to determine if ultrasound (US) could accurately assess the location and severity of adhesions in neonates as an objective dynamic marker capable of informing reoperation timing.
After IRB approval, we conducted a prospective observational study including neonates undergoing abdominal operations. Patients received surgeon-performed US approximately every 2 weeks until reoperation or discharge. Adhesions were assessed in five zones: right upper quadrant (RUQ), right lower quadrant (RLQ), left upper quadrant (LUQ), left lower quadrant (LLQ) and peri-incision (INC).
Over a 6-month study period, 16 neonates were enrolled. Median gestational age was 34 weeks at birth and median weight 2.2 kg. 6 underwent reoperation within initial NICU admission. At time of operation US correctly identified the absence or presence and severity of adhesions in: RUQ (3/3); RLQ (6/6); LUQ (4/5); LLQ (6/6); and INC (5/5).
US can identify location and severity of post-operative adhesions in neonates, potentially identifying patients who can safely undergo reoperation earlier than predetermined wait periods.
IV.
新生儿腹部再次手术较为困难，且可能会出现腹部粘连等并发症。如果能识别出哪些患者可以安全地进行早期再次手术，将有助于减少 TPN 和中心静脉置管天数，降低相关感染和肝损伤风险，缩短新生儿重症监护病房（NICU）和医院的住院时间。我们试图确定超声（US）是否可以准确评估新生儿粘连的位置和严重程度，作为一种能够为再次手术时机提供信息的客观动态标志物。
在获得机构审查委员会（IRB）批准后，我们进行了一项前瞻性观察性研究，纳入了接受腹部手术的新生儿患者。患者在接受外科医生进行的 US 检查后，大约每 2 周进行一次，直到再次手术或出院。粘连在五个区域进行评估：右上象限（RUQ）、右下象限（RLQ）、左上象限（LUQ）、左下象限（LLQ）和切口周围（INC）。
在为期 6 个月的研究期间，共纳入 16 名新生儿。出生时的中位胎龄为 34 周，体重中位数为 2.2 公斤。6 名患者在初次入住 NICU 期间进行了再次手术。在手术时，US 正确识别了粘连的存在与否以及粘连的严重程度：RUQ（3/3）；RLQ（6/6）；LUQ（4/5）；LLQ（6/6）；INC（5/5）。
US 可以识别新生儿术后粘连的位置和严重程度，可能可以更早地识别出哪些患者可以安全地进行再次手术，而无需等待预定的时间。
IV 级。
