Hoehner J C, Ein S H, Kim P C
Division of General Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
J Pediatr Surg. 1998 Jun;33(6):885-8. doi: 10.1016/s0022-3468(98)90666-2.
The incidence of jejuno-ileal atresia in neonates concomitantly found to possess gastroschisis has been reported to be 5% to 25%. Initial treatment for this condition has not been well established.
Thirteen newborns with gastroschisis and coexisting jejuno-ileal atresia, were identified and treated at our institution over the past 16 years (1978 through 1996). Patient characteristics at presentation, surgical therapy, and complications at extended follow-up were reviewed.
All neonates were preterm (mean gestational age, 35.2 +/- 2.0 weeks) and of low birth weight (2.1 +/- 0.4 kg). Atresia types II, IIIa, IIIb, and IV were identified at the initial surgical procedure in one, eight, one, and three patients respectively; however, one synchronous small bowel atresia went unrecognized. A primary anastomosis was fashioned in 8 of 13 newborns, the creation of which did not influence length of hospitalization, length of total parenteral nutrition (TPN) requirement, complication rate, or survival; however, reoperation was required in two of eight patients to mediate anastomotic complications. Atresia associated with intestinal gangrene or perforation was treated by primary anastomosis in three of six patients and the remaining three by enterostomy. Primary abdominal wall closure was possible in 10 of 13 patients; a Silon pouch was required in three. All nine survivors (69%) displayed protracted small bowel dysfunction requiring TPN (mean TPN duration of 3.6 +/- 3.0 months; range, 1 to 11). Mortality in four patients was a consequence of severe prematurity, Silon pouch wound sepsis, or TPN-induced cirrhosis.
When technically feasible, restoration of intestinal continuity by primary anastomosis is a reasonable treatment option in patients with coexisting gastroschisis and jejuno-ileal atresia. Favorable outcome is as much a function of supportive care and parenteral nutrition as the type of surgical repair performed for either the intestinal or the abdominal wall defect.
据报道，新生儿腹裂合并空回肠闭锁的发生率为5%至25%。这种情况的初始治疗方法尚未完全确立。
在过去16年（1978年至1996年）期间，我们机构共识别并治疗了13例患有腹裂并并存空回肠闭锁的新生儿。回顾了患儿就诊时的特征、手术治疗情况以及延长随访期的并发症。
所有新生儿均为早产儿（平均孕周35.2±2.0周）且出生体重低（2.1±0.4千克）。在初次手术中，分别有1例、8例、1例和3例患者被诊断为II型、IIIa型、IIIb型和IV型闭锁；然而，1例同步性小肠闭锁未被识别。13例新生儿中有8例行一期吻合术，其实施并未影响住院时间、全胃肠外营养（TPN）需求时间、并发症发生率或生存率；然而，8例患者中有2例需要再次手术以处理吻合口并发症。6例与肠坏疽或穿孔相关的闭锁患者中，3例行一期吻合术，其余3例行肠造口术。13例患者中有10例可进行一期腹壁关闭；3例需要使用Silon袋。9例存活者（69%）均出现迁延性小肠功能障碍，需要TPN（平均TPN持续时间为3.6±3.0个月；范围为1至11个月）。4例患者死亡的原因是严重早产、Silon袋伤口感染或TPN引起的肝硬化。
在技术可行的情况下，对于并存腹裂和空回肠闭锁的患者，一期吻合术恢复肠道连续性是一种合理的治疗选择。良好的预后不仅取决于手术修复肠道或腹壁缺损的方式，还同样取决于支持治疗和胃肠外营养。
