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,2021,20(11):1048-1053,1069.[doi:10.12260/lcxewkzz.2021.11.010]
先天性胃壁肌层缺损104例诊治分析
- Title:
- 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
- 分类号:
- R573;R656.6;R722
- 摘要:
- 目的 总结不同胎龄先天性胃壁肌层缺损患者的临床特点及治疗效果。方法 以2012年12月至2020年6月湖南省儿童医院新生儿外科、新生儿内科收治的104例经手术及病理证实为先天性胃壁肌层缺损的患者为研究对象。收集患者性别、胎龄、发病日龄、出生体重、首发症状、入院时吸氧及气管插管情况、气腹情况、出现症状到手术的时间、穿孔位置、胃壁肌层缺损长度、手术方式、合并消化道畸形情况、合并其他畸形情况、留置胃管时间、呼吸机使用天数、呼吸衰竭、心力衰竭、低蛋白血症、败血症、开始喂养时间、总住院时间、静脉营养天数、吻合口瘘、再次手术、预后及病理结果等临床资料，并评估治疗效果。结果 104例先天性胃壁肌层缺损患者中男73例（70.2%），女31例（29.8%）；出生胎龄25.43~41.43周，平均（34.4±2.7）周，出生体重840~3 900 g，中位数2 090 g；足月儿17例（16.3%），早期早产儿45例（43.3%），晚期早产儿42例（40.4%）；发病日龄0.3~19.0 d，中位数2.1 d；术前气腹率95.2%；胃穿孔位置：胃前壁大弯侧78例（75%），前壁小弯侧10例（9.6%），后壁大弯侧7例（6.7%）；胃穿孔长度0.5~10.0 cm，中位数6.0 cm；除4例术中放弃治疗外，其余均行一期胃修补术；足月儿与早产儿的平均出生胎龄（38.47周vs.33.63周）、平均出生体重（3.21 kg vs.1.95 kg）差异有统计学意义（P<0.05），气腹发生率（82.4%vs.97.7%）、存活率（70.6%vs.81.6%）差异无统计学意义（P>0.05）。早期早产儿与晚期早产儿的平均中位出生胎龄（32.57周vs.35.29周）、平均出生体重（1.64 kg vs.2.28 kg）、中位呼吸机使用天数[1.3（0.5，2.5） d vs.0（0，0.5） d]、呼吸衰竭发生率（86.7%vs.38.1%）、败血症发生率（22.2%vs.4.8%）、存活率（73.3%vs.90.5%）差异均有统计学意义（P<0.05），但是气腹发生率差异无统计学意义（100%与95.2%，P>0.05）。结论 先天性胃壁肌层缺损多发生于早产儿，胃穿孔的位置多在胃前壁大弯侧；早期早产儿较晚期早产儿呼吸衰竭、败血症、死亡的发生率更高。
- 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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备注/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