中低收入国家先天性腹裂（GS）中转诊时间和手术时间对生存率影响的评估：八年回顾。

Assessment of transfer-time and time-to-surgery as risk factors to survival in Gastroschisis (GS) in a LMIC; an eight-year review.

机构信息

Department of Paediatric Surgery, Kasr AlAiny Faculty of Medicine, Cairo University Specialized Paediatric Hospital, Cairo University, Ali Ibrahim Street, Mounira, Cairo, 11241, Egypt.

出版信息

Pediatr Surg Int. 2024 Nov 7;40(1):295. doi: 10.1007/s00383-024-05872-0.

DOI:10.1007/s00383-024-05872-0

PMID:39508848

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11543767/

Abstract

BACKGROUND

The management of Gastroschisis in LMICs continues to be a challenge and is associated with very poor outcomes in contrast with HICs where survival rates near 100%. The purpose of this work is to provide an overview of survival over the past 8 years in a high-flow tertiary centre in Africa. It also investigates the effect of transfer-time and time-to-surgery on outcome.

METHODS

Retrospective case note review of all GS admissions. The variables assessed were gender, gestational age, weight, type of GS, transfer time, time to surgery and type of surgery. The primary outcome was survival.

RESULTS

A total of 171 GS cases were identified: 148 simple, 23 complex. Seven died before surgery. The median age at surgical intervention was 8.5 h (range, 0-48). Closure options ranged from single-staged (primary fascial, skin, umbilical flap and sutureless closure) or a staged (silo) closure. Overall survival was 34.5%. Cases transferred under 8 h had a 46% survival. Surgery under 12 h of life had highest survival, 45%. Simple GS survived better than complex GS (40% vs 10%). Primary closure had a significantly better survival compared to staged closure (51% vs 18%).

CONCLUSIONS

Transfer-time < 8 h plays a vital role in survival of GS cases. Surgical intervention within 12 h of birth showed a statistically significant improvement in outcome. Primary closure was associated with better survival rates.

LEVEL OF EVIDENCE

Level III.

摘要

背景

在中低收入国家（LMICs），先天性脐膨出的管理仍然是一个挑战，其结果非常差，与高收入国家（HICs）形成鲜明对比，后者的存活率接近 100%。本研究的目的是提供过去 8 年在非洲一家高流量三级中心的生存情况概述。它还调查了转运时间和手术时间对结果的影响。

方法

回顾性分析所有 GS 入院病例。评估的变量包括性别、胎龄、体重、GS 类型、转运时间、手术时间和手术类型。主要结果是生存。

结果

共确定了 171 例 GS 病例：148 例单纯性，23 例复杂性。7 例在手术前死亡。手术干预的中位年龄为 8.5 小时（范围 0-48 小时）。闭合方式包括单阶段（一期筋膜、皮肤、脐瓣和无缝线闭合）或分期（Silo）闭合。总体生存率为 34.5%。转运时间在 8 小时内的病例存活率为 46%。在出生后 12 小时内进行手术的存活率最高，为 45%。单纯性 GS 的存活率优于复杂性 GS（40%比 10%）。一期闭合的存活率明显优于分期闭合（51%比 18%）。