초극소 저출생 체중아에서 복막 배액술의 경험

남소현; 김대연; 김성철; 김애란; 김기수; 피수영; 김인구

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자료유형: 학술저널

저자정보: 남소현 (울산대학교 의과대학 서울아산병원 외과학교실) 김대연 (울산대학교 의과대학 서울아산병원 외과학교실) 김성철 (울산대학교 의과대학 서울아산병원 외과학교실) 김애란 (울산대학교 의과대학 서울아산병원 소아과학교실) 김기수 (울산대학교 의과대학 서울아산병원 소아과학교실) 피수영 (울산대학교 의과대학 서울아산병원 소아과학교실) 김인구 (울산대학교 의과대학 서울아산병원 외과학교실)

저널정보: 대한소아외과학회 Journal of the Korean Association of Pediatric Surgeons : JKAPS Journal of the Korean Association of Pediatric Surgeons : JKAPS 제14권 제1호

발행연도: 2008.1

수록면: 37 - 47 (11page)

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Recently, the survival rates of extremely low-birth-weight (ELBW) infants have improved with the development of neonatal intensive care. However, these infants were susceptible to intestinal perforation due to prematurity, fluid restriction, and injection of indomethacin, etc. Because of the risks of transportation, anesthesia and surgery itself, peritoneal drainage has been compared with laparotomy. Through our experience, we investigate the usefulness of peritoneal drainage retrospectively. From 1997 to 2007, six ELBW (M:F=5:1) underwent primary peritoneal drainage for intestinal perforation. Their median birth weight was 685g (405~870) and gestational age was $25^{+1}$ weeks ($24^{+3}{\sim}27^{+0}$). We noticed the intestinal perforation at median 10.5 days (8~18) after birth, and placed Penrose drain or Jackson-Pratt drain through right lower quadrant incision under local anesthesia. The cause of intestinal perforation was necrotizing enterocolitis in one patient, but that of the others was not clear. Three patients who showed normal platelet count and stable vital signs recovered uneventfully. Two patients (birth weight less than 500g) who showed unstable vital signs and low platelet count (12,000 / $mm^3$ to 30,000 / $mm^3$)expired despite aggressive resuscitation. One patient required laparotomy due to persistent intestinal obstruction after drain removal and survived. Our experience shows that peritoneal drainage was an acceptable treatment for ELBW infants and the prognosis was related to vital sign and platelet count at the time of intestinal perforation, and birth weight.

#Peritoneal drainage #Intestinal perforation #Extremely low-birth-weight infant

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