Håkanson Cecilia Arana, Fredriksson Fanny, Lilja Helene Engstrand
Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18a, 171 77, Solna, Sweden.
Detpartment of Women's and Children's health, Uppsala University, Sweden.
J Pediatr Surg. 2023 Nov;58(11):2249-2254. doi: 10.1016/j.jpedsurg.2023.05.017. Epub 2023 Jun 1.
Intra-abdominal adhesions can lead to adhesive small bowel obstruction (ASBO). The incidence of ASBO is higher in paediatric surgery than in adult surgery. However, ASBO related complications, economic burden and clear management guidelines in the treatment of ASBO are lacking. The aims of this study were to investigate underlying diagnoses, treatments, complications and costs in paediatric ASBO.
An observational retrospective study in children 0-15 years, hospitalised for ASBO during 2000-2020. Data were extracted from the medical records. Complications were classified based on Clavien Dindo Classification of Surgical Complications. Descriptive statistics were presented as median, continuous variables and categorical variables summarised with frequencies. Time to ASBO was presented as a Kaplan-Meier estimate.
In total, 101 patients with 137 episodes of ASBO were included whereof 58.4% underwent first (index) surgery during the neonatal period. Median follow-up was 11.3 (0.6-19) years and median time to the first ASBO was 3.76 months (95%CI 2.23-12.02). The most common diagnoses at index surgery were necrotising enterocolitis, duodenal obstruction and primary ASBO. In 86.6% of the patients, first ASBO did not resolve with conservative treatment and a laparotomy was needed. Postoperative complications were found in 52%. Median cost for one episode of acute ASBO was 36 236 USD (1629-236 159).
Neonatal surgery was the dominating cause of ASBO and surgical intervention the most common treatment with a high frequency of postoperative complications and significant healthcare costs. Future studies are needed to develop safe management guidelines for the treatment of paediatric ASBO.
III.
腹腔内粘连可导致粘连性小肠梗阻（ASBO）。小儿外科中ASBO的发病率高于成人外科。然而，ASBO相关并发症、经济负担以及ASBO治疗中明确的管理指南尚缺乏。本研究的目的是调查小儿ASBO的潜在诊断、治疗、并发症及费用。
对2000年至2020年期间因ASBO住院的0至15岁儿童进行一项观察性回顾性研究。数据从病历中提取。并发症根据Clavien Dindo手术并发症分类进行分类。描述性统计以中位数、连续变量和频率汇总的分类变量表示。ASBO发生时间以Kaplan-Meier估计值表示。
共纳入101例患者，发生137次ASBO发作，其中58.4%在新生儿期接受了首次（索引）手术。中位随访时间为11.3（0.6 - 19）年，首次ASBO的中位时间为3.76个月（95%CI 2.23 - 1十二点零二）。索引手术时最常见的诊断为坏死性小肠结肠炎、十二指肠梗阻和原发性ASBO。在86.6%的患者中，首次ASBO经保守治疗未缓解，需要进行剖腹手术。52%的患者出现术后并发症。一次急性ASBO发作的中位费用为36236美元（1629 - 236159）。
新生儿手术是ASBO的主要原因，手术干预是最常见的治疗方法，术后并发症发生率高，医疗费用高昂。未来需要开展研究以制定小儿ASBO治疗的安全管理指南。
III级
