| Objective: Retrospective analysis of the relevant clinical case data of children with congenital intestinal atresia who underwent surgical treatment in our department in the past 7 years,and to study and summarize the influence of perinatal integrated management mode on the treatment effect of children with congenital intestinal atresia.Methods: Statistics of all case data of children with congenital intestinal atresia who meet the above inclusion criteria from October 2013 to September2020,encompassing the gender of the child,gestational weeks at birth,birth weight,admission time of the child,intervention time for surgery,main clinical symptoms at the time of admission,preoperative WBC count,neutrophil ratio,hs-CRP,PCT,SAA level,surgical method,intraoperative resection of bowel length,proximal bowel diameter,postoperative Histopathological score,days of the first postoperative defecation time,application time of postoperative parenteral nutrition,postoperative hospital stay,total hospital stay and other relevant data,whether prenatal examination,whether the obstetric examination revealed abnormality,whether they were admitted to the hospital through the perinatal integrated management mode.The patients were divided into two groups on the grounds of whether they were admitted to the hospital through the perinatal integrated management mode,and the general information at the time of admission,pre-operation,intra-operation and post-operation information of the two groups were compared.According to the year of admission,the children with intestinal atresia were divided into 7 groups,and compared the intestinal atresia grouped in different years Changes in the proportion of children undergoing prenatal examinations,the proportion of abnormal prenatal examinations,and the proportion of children admitted through the integrated perinatal management model.Results: 1.General information : In this study,there are 128 children with congenital intestinal atresia met the inclusion criteria,of which 39 cases(39.47%)were admitted to the integrated perinatal management model,which was the integrated group.89 cases(69.53%)of non-perinatal integrated management model were admitted to hospital,as non-integrated group.Among128 cases of intestinal atresia in the whole group,there were 68 male children(53.13%)and 60 female children(46.87%),and the ratio of male to female was about 1.13: 1.35(27.3%)premature infants and 93(72.7%)term infants,The ratio is about 0.38:1,the smallest gestational week at birth is 29+2 weeks,the largest gestational week at birth is 41+2 weeks,and the median gestational week at birth is 38 weeks.34 low birth weight infants(26.6%),94 normal birth weight infants(73.4%),the ratio is about 0.36:1;the birth weights ranged from a minimum of 1280 g to a maximum of 4300 g,with a median birth weight of2845g;The proportion of males(66.7%),premature infants(41.0%)and low birth weight infants(43.6%)in the integrated group were higher than those in the non-integrated group(P < 0.05).2.Preoperative information: Among the 128 cases,the shortest time of hospital admission was 0.183 h after birth,only 11 min.The longest time of hospital admission was 26 days after birth,and the median time of hospital admission was 33.500 h(9h30 min).The shortest operation intervention time was 17.667 h(17 h40 min)after birth,and the longest was 634 h(10 h on 26days)after birth,with the median operation intervention time of 90.500 h(18h30 min on 3 days)after birth.The admission time and operation intervention time of children in the integration group were significantly earlier than those in the non-integration group(P < 0.05).Among the 128 cases in the whole group,the total number of WBC increased by 13.28 %,and the neutrophil ratio increased by 18.75 %.The overall increase rate was low,and the difference between the two groups was not obvious(P > 0.05).Preoperative serum hs-CRP,PCT,and SAA elevations were obviously lower than those in the non-integration group.3.Intraoperative information : Among the 128 children with intestinal atresia in the whole group,ileum atresia was the most common,accounting for41.41 %(53 cases),jejunum atresia in 39 cases,duodenal atresia in 34 cases,and colon atresia in 2 cases.In the integrated group,duodenal atresia was the most common,accounting for 46.15 %(18 cases),while in the non-integrated group,ileum atresia was the most common,accounting for 49.44 %(44 cases),and the difference in atresia sites between the two groups was very obviously(P < 0.05).The surgical methods were mainly one-stage anastomosis,including91 cases(71.1 %)of intestinal segment resection + one-stage anastomosis,23cases(18 %)were treated with diaphragm resection + transverse suture of intestinal canal longitudinal resection,5 cases(3.9 %)were treated with duodenal rhomboid anastomosis,4 cases(3.1 %)were treated with duodenal lateral anastomosis,and 5 cases(3.9 %)of enterostomy.There was no intestinal fistula in the integrated group.Of the 128 patients,96 underwent resection of the intestinal canal,including 26 in the integrated group and 70 in the non-integrated group.The average length of resected bowel(13.48 ± 4.42)cm and the average diameter of proximal bowel(3.00 ± 0.77)in the integrated group were smaller than those in the non-integrated group(15.68 ± 4.60)and(3.85 ± 1.01)(P < 0.05).4.Postoperative information: A total of 105 cases underwent pathological examination after surgery.The histopathological scores of children in the integrated group were significantly lower than those in the non-integrated group,and the pathological damage was less severe(P < 0.05).122 cases were cured and discharged from the whole group,with a total cure rate of 95.31%;among them,94.88%(37 cases)were in the integrated group and 95.51%(85 cases)were in the non-integrated group.The first defecation time(median day: 3rd day after surgery),parenteral nutrition application time(median 8 days),postoperative hospital stay(median 13 days)and total hospital stay(median: 16days)in the integration group were obviously shorter than those in the non-integration group,and the patients recovered faster after surgery(P < 0.05).5.Prenatal examination and perinatal integrated management mode:In this study,110 cases(85.94 %)of 128 children underwent prenatal examination,76cases(59.38 %)showed abnormal prenatal examination,but only 39 cases(30.47 %)were admitted to hospital through perinatal integrated management mode,and 37 cases(48.68 %)were lost to follow-up.89 cases were admitted to hospital with non-integrated management mode,including 18 cases without prenatal examination during pregnancy,34 cases without abnormal prenatal examination and 37 cases of prenatal examination revealed abnormalities or suspected intestinal atresia after prenatal examination were not regularly followed up.In accordance with the comparative analysis of admission years,it was found that the proportion of prenatal examination,abnormal prenatal examination and integrated management mode in children with intestinal atresia increased with time(P < 0.05).Conclusion:1.Perinatal integrated management mode can make children with congenital intestinal atresia get early diagnosis and early surgical intervention,which is beneficial to their postoperative recovery.2.The specific implementation process of the perinatal integrated management model still needs to be further optimized to improve maternal compliance and reduce the rate of loss to follow-up. |
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