Factors Affecting the Outcome in Patients with Gastroschisis: How Important Is Immediate Repair?
Factors Affecting the Outcome in Patients with Gastroschisis: How Important Is Immediate Repair?
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DOI：
10.1055/s-0030-1267977
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发表时间：
2011-03-01
影响因子：
1.8
通讯作者：
Klein, M. D.
中科院分区：
文献类型：
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作者：
Alali, J. S.;Tander, B.;Klein, M. D.
背景：30 年来，我们一直在尝试尽早修复腹裂，甚至经常在产房内进行修复。我们检查了最近 12 年的患者记录，以评估立即修复和其他因素对腹裂结果的影响。方法：我们回顾了 1998 年至 2009 年间在密歇根儿童医院出现腹裂的患者 (87) 的医疗记录。专门评估数据以确定修复地点 [产科医院 (“DR”) 与儿童医院 (“OR”)]、修复时间 [小于产后一小时（“IR”）或超过一小时（“ER”）]，以及修复类型[初次筋膜修复和皮肤闭合（“PR”）与分期修复（“SR”）]。结果：PR 组患者更有可能花费一周或更短的时间进行 MV（PR 组为 66%，SR 组为 11%，p < 0.01）。 DR 组患者接受 TPN 的时间更有可能为 2 周或更短，PR 组患者也是如此（PR 组为 51%，SR 组为 17%，p < 0.01）。 PR组患者住院时间少于3周的可能性更大，但IR组和ER组的住院时间几乎相同。 19 名患者 (29%) 存在主要相关异常。这些患者以及很少或没有剥离的患者在我们的每项结果测量中往往优于那些有剥离的患者。结论：产后立即修复有利于实现缺损的初步闭合，从而缩短辅助通气和肠外营养的时间，并缩短住院时间。
Background: Since 30 years, we have attempted to repair gastroschisis as early as possible, often even in the delivery room. We examined 12 recent years of patient records to evaluate the effect of immediate repair and other factors on the outcome of gastroschisis.Methods: We reviewed the medical records of patients presenting with gastroschisis (87) at the Children's Hospital of Michigan between 1998 and 2009. Data were evaluated specifically to determine the effect of the place of repair [obstetric hospital ("DR") vs. children's hospital ("OR")], the time of repair [less than an hour after delivery ("IR") or more than one hour ("ER")], and the type of repair [primary fascial repair and skin closure ("PR") vs. staged repair ("SR")].Results: Patients in the PR group were more likely to spend one week or less on MV (66% in PR vs. 11% in SR, p < 0.01). Patients in the DR group were more likely to spend 2 weeks or less on TPN, as were patients in the PR group (51% in PR vs. 17% in SR, p < 0.01). Patients in the PR group were more likely to stay in hospital for less than 3 weeks, but the IR and ER groups had almost same hospital stay. Major associated anomalies were present in 19 patients (29%). These patients and those with little or no peel tended to outperform those with peel in each of our outcome measures.Conclusion: Repair immediately after delivery is beneficial in terms of achieving primary closure of the defect, leading to shorter times on assisted ventilation and parenteral nutrition, and shorter hospital stays.