努力改善复杂肠闭锁新生儿的结局：单一中心低收入国家的经验。
Efforts to improve outcomes among neonates with complex intestinal atresia: a single-center low-income country experience.
机构信息
Mulago National Referral Hospital, Kampala, Uganda.
Department of Surgery, Center for Health Equity and Anesthesia, University of California - San Francisco, San Francisco, USA.
出版信息
Pediatr Surg Int. 2024 Mar 6;40(1):70. doi: 10.1007/s00383-024-05639-7.
PURPOSE
Intestinal obstruction caused by intestinal atresia is a surgical emergency in newborns. Outcomes for the jejunal ileal atresia (JIA), the most common subtype of atresia in low-income countries (LIC), are poor. We sought to assess the impact of utilizing the Bishop-Koop (BK) approach to JIA in improving outcomes.
METHODS
A retrospective cohort study was performed on children with complex JIA (Type 2-4) treated at our national referral hospital from 1/2018 to 12/2022. BK was regularly used starting 1/1/2021, and outcomes between 1/2021 and 12/2022 were compared to those between 1/2018 and 12/2020. Statistical significance was set at p < 0.05.
RESULTS
A total of 122 neonates presented with JIA in 1/2018-12/2022, 83 of whom were treated for complex JIA. A significant decrease (p = 0.03) was noted in patient mortality in 2021 and 2022 (n = 33, 45.5% mortality) compared to 2018-2020 (n = 35, 71.4% mortality). This translated to a risk reduction of 0.64 (95% CI 0.41-0.98) with the increased use of BK.
CONCLUSION
Increased use of BK anastomoses with early enteral nutrition and decreased use of primary anastomosis improves outcomes for neonates with severe JIA in LIC settings. Implementing this surgical approach in LICs may help address the disparities in outcomes for children with JIA.
目的
肠闭锁引起的肠梗阻是新生儿的外科急症。在低收入国家（LIC），最常见的闭锁类型——空肠回肠闭锁（JIA）的预后较差。我们试图评估采用 Bishop-Koop（BK）方法治疗 JIA 对改善结局的影响。
方法
对 2018 年 1 月至 2022 年 12 月在我们国家转诊医院接受治疗的复杂 JIA（类型 2-4）患儿进行回顾性队列研究。从 2021 年 1 月 1 日起，常规使用 BK 方法，比较 2021 年 1 月至 12 月与 2018 年 1 月至 12 月的结果。统计显著性设为 p < 0.05。
结果
2018 年 1 月至 2022 年 12 月共有 122 例新生儿出现 JIA，其中 83 例接受复杂 JIA 治疗。2021 年和 2022 年（n=33，45.5%死亡率）患者死亡率显著下降（p=0.03），而 2018 年至 2020 年（n=35，71.4%死亡率）死亡率较高。这意味着随着 BK 吻合术的增加和肠内营养的早期应用，以及初次吻合术的减少，风险降低了 0.64（95%CI 0.41-0.98）。
结论
在 LIC 环境中，增加 BK 吻合术、早期肠内营养和减少初次吻合术的应用可改善严重 JIA 新生儿的结局。在 LIC 中实施这种手术方法可能有助于解决 JIA 患儿的结局差异。
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