Wang Dajia,Zhang Zhibo,Bai Yuzuo,et al.Comparison of intrapartum versus non-intrapartum operations for congenital abdominal wall defects[J].Journal of Clinical Pediatric Surgery,,21():833-837.[doi:10.3760/cma.j.cn101785-202206003-007]
Comparison of intrapartum versus non-intrapartum operations for congenital abdominal wall defects
- Keywords:
- Infant; Newborn; Abdominal Wall/SU; Fetal Therapies
- Abstract:
- Objective To compare the safety and efficacy of intrapartum operation with those of non-intrapartum operation in neonates with congenital abdominal wall defects.Methods From January 2009 to December 2021, clinical data were retrospectively for 70 neonates with congenital abdominal wall defects.There were gastroschisis (n=12) and omphalocele (n=58).Intrapartum (n=34) and non-intrapartum (n=36) operations were performed.Staging operation, mesh application, blood transfusion, exogenous blood transfusion, ventilator use, incision infection, hypoglycemia, liver damage, central vein-related infection, antibiotic use, intravenous nutrition time, feeding time, length of hospital stay, recovery and postoperative follow-ups were compared between two groups.Results There were zero and eight cases of exogenous transfusion in intrapartum and non-intrapartum operation groups (P < 0.05).Umbilical cord blood transfusion was performed in intrapartum operation group (n=4, P=0.25).And there were three and one case of staging operation in intrapartum and non-intrapartum operation groups (P=0.28).Patch repair was performed (n=1 each, P=1.00).Postoperative incision infection occurred in one and four cases in intrapartum and non-intrapartum operation groups (P=0.18) and the difference was not statistically significant.There were zero and two cases with central vein-related infection in intrapartum and non-intrapartum operation groups (P=0.49) and the difference was not statistically significant.No significant inter-group differences existed in ventilator support, TPN time, milk opening time, antibiotic use or hospital stay.Intrapartum operation group had a curative rate of 97.06% (one neonate withdrawing from the hospital) and non-intrapartum operation group had a curative rate of 97.22% (one neonate death due to respiratory failure); the difference was not statistically significant.Follow-up results showed that height and weight in two groups were within two standard deviations of each other for children of the same age.The development of nervous system was normal and there was no case of reoperation for intestinal obstruction.Conclusion Intrapartum and non-intrapartum operations are equally safe and effective for treating congenital abdominal wall defects.Neonates undergoing intrapartum operation do not need exogenous blood transfusion to avoid risks associated with allogeneic blood transfusion.
References:
[1] 中华医学会小儿外科学分会新生儿外科学组.常见胎儿结构畸形产前咨询儿外科专家共识[J].中华小儿外科杂志, 2020, 41(12):1057-1068.DOI:10.3760/cma.j.cn421158-20200228-00126. Neonatal Surgery Group, Pediatric Surgery Society, Chinese Medical Association. Pediatric Surgical Expert Consensus on Prenatal Consultation for Common Fetal Structural Abnormalities[J].Chin J Pediatr Surg, 2020, 41(12):1057-1068.DOI:10.3760/cma.j.cn421158-20200228-00126.
[2] Khan FA, Hashmi A, Islam S.Insights into embryology and development of omphalocele[J].Semin Pediatr Surg, 2019, 28(2):80-83.DOI:10.1053/j.sempedsurg.2019.04.003.
[3] Oakes MC, Porto M, Chung JH.Advances in prenatal and perinatal diagnosis and management of gastroschisis[J].Semin Pediatr Surg, 2018, 27(5):289-299.DOI:10.1053/j.sempedsurg.2018.08.006.
[4] Wissanji H, Puligandla PS.Risk stratification and outcome determinants in gastroschisis[J].Semin Pediatr Surg, 2018, 27(5):300-303.DOI:10.1053/j.sempedsurg.2018.08.007.
[5] Petrosyan M, Sandler AD.Closure methods in gastroschisis[J].Semin Pediatr Surg, 2018, 27(5):304-308.DOI:10.1053/j.sempedsurg.2018.08.009.
[6] Chen XY, Yang JX, Zhang HY, et al.Ex utero intrapartum treatment for giant congenital omphalocele[J].World J Pediatr, 2018, 14(4):399-403.DOI:10.1007/s12519-018-0129-7.
[7] 施诚仁, 蔡威, 王俊, 等.小儿外科畸形早期外科干预新途径——产房外科的可行性[J].临床儿科杂志, 2005, 23(2):98-100.DOI:10.3969/j.issn.1000-3606.2005.02.012. Shi CR, Cai W, Wang J, et al.A novel approach to treating neonatal abnormalities in an earlier stage-Feasibility of delivery room surgery system[J].J Clin Pediatr, 2005, 23(2):98-100.DOI:10.3969/j.issn.1000-3606.2005.02.012.
[8] Verla MA, Style CC, Olutoye OO.Prenatal diagnosis and management of omphalocele[J].Semin Pediatr Surg, 2019, 28(2):84-88.DOI:10.1053/j.sempedsurg.2019.04.007.
[9] Beaudoin S.Insights into the etiology and embryology of gastroschisis[J].Semin Pediatr Surg, 2018, 27(5):283-288.DOI:10.1053/j.sempedsurg.2018.08.005.
[10] Bhat V, Moront M, Bhandari V.Gastroschisis:A State-of-the-Art Review[J].Children (Basel), 2020, 7(12):302.DOI:10.3390/children7120302.
[11] Gonzalez KW, Chandler NM.Ruptured omphalocele:Diagnosis and management[J].Semin Pediatr Surg, 2019, 28(2):101-105.DOI:10.1053/j.sempedsurg.2019.04.009.
[12] Tauriainen A, Sankilampi U, Raitio A, et al.The association of perinatal and clinical factors with outcomes in infants with gastroschisis-a retrospective multicenter study in Finland[J].Eur J Pediatr, 2021, 180(6):1875-1883.DOI:10.1007/s00431-021-03964-w.
[13] 王鹏, 黄寿奖, 秦琪, 等.一期手术治疗严重腹壁缺损及手术后腹腔压力变化探讨[J].临床小儿外科杂志, 2018, 17(2):122-125.DOI:10.3969/j.issn.1671-6353.2018.02.009. Wang P, Huang SJ, Qin Q, et al.Application of one-stage operation for severe abdominal wall defect and postoperative abdominal pressure variations[J].J Clin Ped Sur, 2018, 17(2):122-125.DOI:10.3969/j.issn.1671-6353.2018.02.009.
[14] Suominen J, Rintala R.Medium and long-term outcomes of gastroschisis[J].Semin Pediatr Surg, 2018, 27(5):327-329.DOI:10.1053/j.sempedsurg.2018.08.008.
[15] Baerg JE, Munoz AN.Long term complications and outcomes in omphalocele[J].Semin Pediatr Surg, 2019, 28(2):118-121.DOI:10.1053/j.sempedsurg.2019.04.004.
[16] Emil S.Surgical strategies in complex gastroschisis[J].Semin Pediatr Surg, 2018, 27(5):309-315.DOI:10.1053/j.sempedsurg.2018.08.003.
Memo
收稿日期:2022-06-30。
基金项目:辽宁省重点研发计划联合计划（2020JH2/10300131）；辽宁省兴辽英才计划（XLYC1908008）
通讯作者:张志波,E-mail:zhangzb@sj-hospital.org