接受结肠造口术的肛门直肠畸形患者的流失率:一个值得关注的问题

Q4 Medicine
Parveen Kumar, Sauradeep Dey, Ashvin Damdoo, Shishir Kumar, V. Manchanda
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引用次数: 0

摘要

背景:肛门直肠畸形(ARM)是一种可矫正的先天性畸形,预后良好。传统的处理方法是分期手术,先进行分流结肠造口术,然后在第三期进行最终手术和造口翻转术。我们建议患者在 6 个月大之前完成所有阶段的修复手术,以便更好地保持长期排便通畅。与因 ARM 而接受结肠造口术的患者相比,前来接受最终手术和造口翻转术的患者较少,因此我们计划开展这项研究,以了解因 ARM 而接受造口术的患者的流失率,并探讨其原因:方法:我们在新德里 Chacha Nehru Bal Chikitsalaya 小儿外科开展了一项观察性研究。检索了 2018 年 1 月至 2019 年 12 月期间在本中心接受分流造口术的所有 ARM 患者的病例记录。通过相同的唯一健康识别码(UHID)检索了进一步的随访病例记录。如果到 2022 年 12 月仍未在医院记录中找到明确手术/造口关闭的病例,则电话联系患儿家长,以了解患儿是否在其他中心接受了明确手术、正在等待手术或已经死亡。自然减员的计算方法是:在数据采集前,已完成造口手术的患者人数与已完成手术并关闭造口的患者人数之差:共有 105 名患者参与研究,其中男性居多。73.33%的患者在新生儿期进行了结肠造口术(77/105)。发现泄殖腔畸形的有 7 例(6.67%),直肠闭锁的有 6 例(5.71%),先天性袋状结肠的有 9 例(8.57%)。ARM 造口的年龄从 1 天到 9.3 岁不等(平均 0.67 ± 1.96 岁)。心脏和肾脏异常是主要的关联因素。28名新生儿(26.67%)有造口并发症。32.4%的新生儿有气孔问题。37名患者(35.24%)死亡,其中包括35名新生儿。我们的研究发现流失率为 38.24%(68 例中有 26 例)。导致减员的因素包括贫血、等待时间过长、麻醉师追求患者最佳稳定状态,以及护理人员面临的家庭或个人问题:结论:在造口手术的 ARM 患者中,自然减员率很高。结论:造口手术的 ARM 患者流失率很高,主要原因是贫血和手术等待时间过长。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Attrition rate among patients of Anorectal Malformations on colostomy: A matter of concern
Background: Anorectal malformations (ARM) are correctable congenital malformations with good prognosis. Traditionally it is managed by staged procedure, with diversion colostomy, followed by definitive procedure and stoma reversal in the third stage. It is recommended to complete all stages of repair by 6 months of age for better long-term continence. We had fewer patients coming for definitive surgery and stoma reversal than the patients undergoing colostomy for ARM, so we planned this study to find out the attrition rate among patients undergoing stoma for ARM and explore the reasons for the same. Methods: An observational study was conducted in the Pediatric Surgery department of Chacha Nehru Bal Chikitsalaya, New Delhi. All the case records of patients with ARM who underwent diversion stoma at our center from January 2018 to December 2019 were retrieved. Further follow-up case records were retrieved with the same Unique Health Identification Number (UHID). When the definitive surgery/ stoma closure was not found in the hospital records till December 2022, the parents were contacted telephonically to find out if the children had undergone definitive surgery at some other center, were awaiting surgery, or had died. The attrition was calculated as the difference between the number of patients for whom a stoma was done and the number of patients who underwent definitive surgery and stoma closure till the data acquisition. Results: A total of 105 patients were included in the study with male preponderance. Colostomy was done for 73.33% of patients in the neonatal period (77/105). The cloacal malformation was found in 7 (6.67%), rectal atresia in 6 (5.71%), and 9 had congenital pouch colon (8.57%). The age at stoma creation for ARM ranged from 1 day to 9.3 years (mean 0.67 ±1.96 years). Cardiac and renal anomalies were among the major associations. 28 of the neonates (26.67%) had stomal complications. Stomal issues were reported in 32.4%. Mortality was reported in 37 patients (35.24%) including 35 neonates. The attrition rate in our study was found to be 38.24% (26 out of 68). Factors contributing to attrition range from anemia and protracted waiting lists to the anesthesiologist’s pursuit of optimal patient stabilization, alongside familial or personal matters faced by caregivers. Conclusion: There was a high attrition rate in operated patients of ARM in whom stoma was constructed. The main reasons for the same were anemia and a long surgical waiting list.
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来源期刊
Journal of Neonatal Surgery
Journal of Neonatal Surgery Medicine-Surgery
CiteScore
0.30
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0.00%
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29
审稿时长
6 weeks
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