Clinical characteristics and prognostic factors of neonatal gastric perforation
10.3760/cma.j.113903-20190710-00436
- VernacularTitle:新生儿胃穿孔的临床特点及影响预后的因素
- Author:
Baohong ZHAO
1
;
Hongxia REN
;
Xiaobing SUN
;
Xiaoxia WU
;
Yuanyuan JIN
;
Wenyue LIU
;
Liang ZHAO
;
Hui ZHANG
;
Xin GUO
;
Xue SUN
Author Information
1. 山西省儿童医院新生儿外科，太原 030013
- From:
Chinese Journal of Perinatal Medicine
2020;23(4):239-244
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical characteristics and experience in the diagnosis and treatment of neonatal gastric perforation, and the factors influencing prognosis.Methods:This was a retrospective analysis involving 49 neonatal gastric perforation cases who underwent surgical treatment in the Neonatal Surgery Department of Shanxi Children's Hospital from January 2008 to December 2017. Their clinical data, including manifestations, auxiliary examinations, operations, and prognosis, were analyzed. According to the prognosis, these patients were divided into two groups, survival group, and fatality group. Independent sample t-test or continuity correction Chi-square (or Fisher's exact) test was used for statistical analysis. Results:(1) Of the 49 cases, 29 (59.2%) were boys, and 20 (40.8%) were girls. There were 30 (61.2%) premature and 19 (38.8%) full-term babies. Their birth weight ranged between 1 010 and 5 000 g with an average of (2 450±700) g. Low birth weight infants accounted for 59.2% (29/49). There were 11 cases (22.4%) having perinatal adverse events, 17 (34.7%) complicated by septic shock before the operation, and six (12.2%) with digestive tract malformation. Two cases (4.1%) underwent resuscitation due to postnatal asphyxia; two (4.1%) received mechanical ventilation due to respiratory distress syndrome; 12 (24.5%) received indwelling were indwelled gastric tube or gastric lavage. (2) The average onset time of neonatal gastric perforation in the 49 cases was (3.8±2.0) d after birth, and 47(95.9%) of them presented initial symptoms within one week, including 36 within four days. Twenty-five cases (51.0%) were operated within 12 h after the onset. (3) The common first symptoms include abdominal distention [69.4% (34/49)] and abdominal distension complicated with vomiting (24.5%, 12/49). Thirty-nine cases (79.6%) showed a large amount of free gas under the diaphragm, compressed and down-moving liver, and decreased or disappeared stomach bubble in the preoperative abdominal radiograph. (4) All cases received emergency laparotomy and primary gastric wall repair after admission. During the operation, 27 (55.1%) of all the cases had perforation at the greater curvature, five (10.2%) at the lesser curvature, 14 (28.6%) at the anterior wall, and three (6.1%) at the posterior wall. Perforation larger than 3 cm in diameter was found in 33 cases (67.3%). Three cases (6.1%) had postoperative wound infection; two (4.1%) developed anastomotic leakage; one was complicated by pneumohydrothorax 48 h after the operation due to esophageal duplication and perforation, which was confirmed by a second operation. (5) Of the 49 cases, 35 (71.4%) were due to congenital gastric wall muscular defect, four (8.2%) were caused by iatrogenic injury, and 10 (20.4%) were spontaneous perforation. (6) Among all cases, 36 (73.5%) survived, while eight (16.3%) died, and five (10.2%) withdraw treatment after the operation. After excluding the five cases giving up treatment after the operation, the proportion of patients who underwent operation within 12 h after onset or had the perforation <3 cm in diameter was higher in the survival group than in the fatality group [61.1% (22/36) vs. 1/8, χ2=4.404, P<0.05; 41.7% (15/36) vs. 0/8, P<0.05], and the incidence of septic shock before the operation was lower [22.2% (8/36) vs. 6/8, χ2=6.147, P<0.05]. Conclusions:Neonatal gastric perforation shows a high mortality rate, and its underlying pathologic etiology is congenital gastric wall muscle defect. Abrupt abdominal distension is the main clinical manifestation. Early operation is critical to improving neonatal prognosis.
