Feng Yong,Zhou Chonggao,Li Bixiang,et al.Clinical diagnosis and treatment of congenital defects of gastric musculature:a report of 104 cases[J].Journal of Clinical Pediatric Surgery,,20():1048-1053,1069.[doi:10.12260/lcxewkzz.2021.11.010]
Clinical diagnosis and treatment of congenital defects of gastric musculature:a report of 104 cases
- Keywords:
- Congenital Defect of Gastric Musculature/CN; Gastric Perforation; Infant; Newborn; Infant; Premature
- CLC:
- R573;R656.6;R722
- Abstract:
- Objective To explore clinical diagnosis and treatment of congenital defects of gastric musculature in different gestational ages. Methods From December 2012 to June 2020, clinical data were retrospectively reviewed for 104 neonates of congenital defects of gastric musculature undergoing surgical interventions and pathological examination. The relevant clinical data included gender, gestational age, age of onset, birth weight, symptom onset, oxygen/endotracheal intubation, pneumoperitoneum, time from onset of symptoms to surgery, perforation location/length, surgical approach, gastrointestinal abnormalities, other malformations, time of withdrawing gastric tube, ventilator duration, respiratory failure, heart failure, hypoalbuminemia, milk feeding time, sepsis, hospitalization length, days of intravenous nutrition, anastomotic fistula, reoperation, prognosis and pathological results. Results There were 73 males (70.2%) and 31 females (29.8%) with a mean gestational age of (34.4±2.7)(25+2-41+2) weeks and a median birth weight of 2090(840-3900) gram. There were 17 full-term infants (16.3%), 45 early preterm infants (43.3%) and 42 late preterm infant (40.4%);the median age of onset was 2.1(0.3-19.0) days;the preoperative pneumoperitoneum rate was 95.2%;the site of perforation were located on anterior wall of greater curvature (n=78, 75%), lesser curvature of front wall (n=10, 9.6%) and greater curvature of rear wall (n=7, 6.7%);the median perforation length was 6.0(0.5-10.0) cm;Except for 4 cases giving up during operation, the remainders underwent one-stage gastric repair;The average gestational age, average birth weight, pneumoperitoneum rate and survival rate of term/preterm infants were 38.47 vs. 33.63 weeks (P<0.05), 3.21 vs. 1.95 kg(P<0.05), 82.4% vs. 97.7%(P>0.05) and 70.6% vs. 81.6% (P>0.05) respectively. The median gestational age, average birth weight, median ventilator duration, pneumoperitoneum rate, respiratory failure rate, sepsis rate and survival rate of early/late preterm infants were 32.57 vs. 35.29 weeks (P<0.05), 1.64 vs. 2.28 kg (P<0.05), 1.3(0.5, 2.5) vs. 0(0, 0.5) days (P<0.05), 100% vs. 95.2% (P>0.05), 86.7% vs. 38.1%(P<0.05), 22.2% vs. 4.8% (P<0.05) and 73.3% vs. 90.5% (P<0.05) respectively. Conclusion Congenital defects of gastric musculature usually occur in premature infants. The most common site of perforation is located on anterior wall of greater curvature. Early preterm infants have higher rates of respiratory failure, sepsis and mortality than late preterm counterparts.
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Memo
收稿日期:2020-11-15。
基金项目:湖南省出生缺陷协同防治科技重大专项（编号：2019SK1010）
通讯作者:周崇高,Email:zhouchonggao@sina.com