程序化包扎法、延期手术治疗巨型脐膨出的疗效分析

目的探讨新生儿期采用程序化包扎法、延期手术治疗巨型脐膨出的安全性和有效性。方法回顾性分析2016年12月至2018年7月广州市妇女儿童医疗中心收治的采用程序化包扎法,延期手术治疗的巨型脐膨出患儿临床资料。结果7例患儿出生时囊膜均无破裂,包扎期待治疗期间无囊膜感染、破裂、肠梗阻、中断包扎等并发症发生,未再次入院;囊膜达到干痂期中位数时间为5(4~5)d,囊膜完成上皮化中位数时间为65(57~68)d,家长培训时间中位数6(3~12)d,住院时间中位数21(19~29)d;7例患儿均存活,其中6例行腹壁缺损修补手术,2例术后分别需要5 h和17 h呼吸机支持,住院时间中位数9.5(7.25~10.25)d,术后均未出现伤口预后不良、切口疝等手术并发症。1例正在等待延期修补术。结论程序化包扎法、延期手术治疗巨型脐膨出的方法是安全有效的,其对巨型脐膨出远期预后的影响需进一步随访研究。     

经囊膜悬吊顺序还纳脏器治疗巨型脐膨出

先天性脐膨出是指腹壁的发育缺损,腹腔内脏通过脐部缺损突人脐带基底部,外面覆盖一层囊膜.巨型脐膨出是指脐周腹壁缺损直径超过6 cm的脐膨出,除肠道外,伴有实质性脏器或膀胱脱出体外,尤其是肝脏的疝出是本型的标志.由于腹壁缺损大,并发畸形多,对于巨大脐膨出的治疗方案,目前还有很多争议.如何提高巨大脐膨出的治愈率仍是小儿外科医师面对的难题.我们尝试使用经囊膜悬吊顺序还纳治疗巨型脐膨出,取得满意疗效.     

巨型脐膨出分期整复修补术

脐膨出是一种较常见的先天性腹壁发育不全，腹腔内脏器通过脐带基底部的腹壁缺损膨出于腹腔外，表面覆盖由壁层腹膜和羊膜构成的囊膜。腹壁缺损直径小于5cm者称为小型脐膨出，膨出物多为肠管，易于还纳，常在出生后立即行一期腹壁缝合修补术。腹部缺损直径大于5cm者称巨型脐膨出，膨出物除肠管外还包括肝脏等实质性脏器，不易回缩。     

用硅胶袋修复巨型脐膨出与腹裂13例报告

目的总结应用硅胶袋分期修复巨型脐膨出和腹裂的治疗经验。方法回顾性分析2003年以来应用硅胶袋进行分期腹壁修补术的11例患儿病例资料。其中巨型脐膨出3例，腹裂8例。均于气管插管全身麻醉下手术，将无菌硅胶袋与腹壁缺损边缘缝合成囊袋状，包裹膨出的脏器，术后逐渐挤压囊袋至内脏还纳入腹腔后去除囊袋，分层关闭腹壁缺损。脐膨出患儿行脐部成形。全部患儿术后均予呼吸机支持2-24h。结果全组患儿膨出脏器均于术后7-10d还纳入腹腔．此时腹壁无明显张力．术后无腹壁切口裂开及腹腔继发感染，伤口恢复良好，生长发育正常。结论采用无菌硅胶袋替代涤纶补片行腹壁修补术，硅胶袋与腹壁缝合后反应小，费用低，是一种安全、疗效可靠的方法。     

脱细胞异体真皮基质补片在新生儿及小儿腹壁重建中的应用

目的探讨使用脱细胞异体真皮基质生物补片重建腹壁的方式治疗新生儿、小儿巨型脐膨出等巨大腹壁缺损病例的可行性。方法作者近期采用脱细胞异体真皮基质生物补片重建腹壁的手术方式,治疗巨型脐膨出11例,医源性巨大腹壁缺损1例,巨大腹壁疝1例,通过生物补片修补腹壁组织缺损,扩大腹腔容积,避免直接缝合关闭腹腔术后腹压急剧升高。结果11例巨型脐膨出患儿中,除1例患儿家长放弃治疗外,其余10例效果良好,随访至今,无一例发生并发症。结论新生儿及小儿巨大腹壁缺损可使用脱细胞异体真皮基质补片重建腹壁,效果良好。     

应用自身脐带组织修复脐膨出患者腹壁缺损一例并文献复习

正脐膨出是常见的严重先天性腹壁缺损性疾病,发病率为活产儿的1/4 000～1/7 000,是一种腹壁中线位置的缺损性疾病[1]。脐膨出分为三类:小型脐膨出、巨型脐膨出和疝囊破裂型脐膨出[2,3]。巨型脐膨出的标准是腹壁缺损直径5 cm, 其中肝脏疝出占50%～75%[2,4]。较大脐膨出或伴有肝脏膨出的病死率为4%～37%。巨型脐膨出的治疗目前没有公认的标准手术方式[5]。由于腹壁发育不良,存在较大的腹壁缺损,     

同种异体脱细胞真皮修补术治疗巨型脐膨出的疗效分析

目的总结采用同种异体脱细胞真皮修补术治疗巨型脐膨出的临床经验。方法回顾性分析2014年3月至2019年11月应用同种异体脱细胞真皮修补术治疗的31例巨型脐膨出患儿病例资料,其中男童18例,女童13例,体重1.8~3.5 kg,腹壁缺损均>5 cm,就诊时间1 h至1 d,手术均在就诊后3~12 h内完成,31例羊膜囊内均有小肠、结肠、肝脏。合并先天性心脏病12例(法洛四联症、室间隔缺损、房间隔缺损、动脉导管未闭),合并21-三体畸形1例,合并多指1例,合并肠闭锁1例,合并梅克尔憩室2例,合并肠旋转发育不良3例。术中切除羊膜囊,合并心脏畸形者先观察暂不予处理;合并多指者待患儿3个月再行手术切除;合并肠闭锁者直接行肠切除、肠吻合术;合并梅克尔憩室但肠道通畅者未作处理;合并肠旋转发育不良者行Ladd矫治术。分离脐部缺损周边肌肉组织,将生物补片与肌肉缝合修补缺损,行脐部成形术。术后呼吸机辅助通气2~5 d,7 d后慢慢开奶。出院后随访1年。结果31例患儿均治愈出院,1例发生补片排斥反应,反复发热、渗液,伤口裂开,对症治疗后慢慢好转。2例脐部伤口愈合欠佳,形成巨大瘢痕填充。1例出现腹壁疝,腹腔容积扩张不满意,脐部肿物突出明显,择期再次行手术治疗。2例术后肠梗阻,保守治疗后好转。结论对于巨型脐膨出,同种异体脱细胞真皮修补兼容性好,不良反应少,术后恢复可,并发症少,是一种理想的治疗巨型脐膨出的方法。     

巨型脐膨出二期皮瓣修补改良术

巨型脐膨出二期皮瓣修补改良术王波，傅金祥，杨健，冯家钧脐膨出是先天性腹壁发育畸形中多见的一种。由于近年来新的治疗方法应用，疗效有所提高，但病死率仍较高，尤其是巨型脐膨出。我们采用二期皮瓣修补改良术治疗巨型脐膨出，取得了满意的效果。１．临床资料：１９９...     

先天性脐膨出32例报告

脐膨出是指一种先天性腹壁发育不全,在脐带周围发生缺损,腹腔内脏税出于体外的新生儿畸形。本病不多见,为新生儿先天性急症之一,处理不当病死率高。我院1963年1月～1986年6月共收治本病32例,其中1981年以前收治20例,住院期间死亡7例,病死率为35.0％;自1981年成立新生儿科以来,收治12例,死亡1例,病死率为8.3％。病死率有明显下降,现分析如下。临床资料一、性别、年龄:男22例,女10例。住院时日龄为生后3小时～7天。二、腹壁缺损大小:本组脐膨出按腹壁缺损大小分二型,(1)巨型脐膨出,腹壁缺损环直径≥5cm,15例;(2)小型     

涤纶袋分期修复先天性腹裂和脐膨出23例

先天性腹裂和脐膨出均为新生儿期严重的腹壁发育畸形 ,以往死亡率高达 80 %以上 ,由于医疗材料的进步、对腹腔高压造成危害的逐步认识、围手术期监护及管理的加强 ,治愈率明显提高。我院 1986～ 2 0 0 1年收治 2 3例 ,采用涤纶袋分期修补 ,收到良好疗效 ,现报告如下。临床资料一、一般资料　男 18例 ,女 5例 ;出生 2～ 2 6h入院 ,平均 9.7h ;体重 1.8～ 3.2kg。均为顺产。腹裂 8例 ,脐膨出15例 ;腹裂位于右侧腹壁 7例 ,左侧 1例。裂口长 3.5～ 5 .5cm ,外露小肠 ,结肠污染 ,肠壁水肿。脐膨出患儿膨出部仅见囊膜包裹 ,腹壁缺损直径 4 .5～ 8c…     

Elastic bandaging facilitates primary closure of large ventral hernias due to giant omphaloceles

Large ventral hernias (VH) following conservative treatment of a giant omphalocele are a major challenge for pediatric surgeons. Although primary closure is accepted as the ideal procedure, these defects often require multi-staged operations, prosthetic support, and postoperative mechanical ventilation. Between 1990 and 2000, 34 patients with omphaloceles were admitted to our unit and 6 of them (17.6%) who had giant omphaloceles were treated conservatively. In the same period, a 5-year-old girl was admitted with a huge VH following application of subcutaneous tissue expanders in another center. In these 7 patients (6 girls, 1 boy, average age 20 months) we used preoperative elastic bandaging for facilitating primary closure. In all cases primary closure was successful following 3 to 6 weeks of bandaging. We did not use prosthetic material or postoperative mechanical ventilation in any case. Follow-up periods ranged from 2 to 10 years, and there were no recurrences or other problems. Out limited experience reveals that preoperative elastic bandaging is a safe and effective procedure for facilitating primary closure of the large VHs. Accepted: 16 February 2001     

囊膜破裂型脐膨出并脱出肠管扭转嵌顿伴回肠闭锁的诊治及文献复习

目的 总结囊膜破裂型脐膨出(ruptured omphalocele,RO)的诊治经验.方法 回顾性分析赣南医学院第一附属医院收治的1例RO并脱出肠管扭转嵌顿伴回肠闭锁患儿临床资料,同时检索PubMed、Springer Link、Google Scholar、中国生物医学文献数据库、中国知网、万方和维普数据库,对关键...     

经脐静脉插管的临床应用

目的 探讨经脐静脉插管在脐带干结新生儿中应用的可行性.方法 自2008年3月至12月,在27例脐带干结新生儿中实施经脐静脉插管.插管日龄为3～11 d,平均为（4.5±1）d.结果 插管成功率为88.9%,留置时间为2～10 d,平均为（7±1.3）d,无血管内导管相关血流感染和血栓栓塞并发症.结论 在脐带干结的新生儿中,经脐静脉插管简便易行.     

Giant umbilical cord associated with cord hemangioma

A 6-h-old girl was transferred to the Pediatric Surgery Department of Sisli Children's Hospital due to a giant umbilical cord. Radiologic and laboratory studies were within normal limits. The umbilical mass excised through an intraumbilical incision and the umbilicus reconstructed. Pathologic investigation demostrated an umbilical cord hemangioma located near the umbilical end, compressing the cord structures externally. The remaining cord consisted of loose, edematous stroma similar to Wharton's jelly. The patient was discharged from the hospital on the 5th postoperative day and remains healthy 1 year later. Umbilical cord hemangioma should be considered in the etiology of a giant umbilical cord.     

Non-operative management of giant omphalocele with topical povidone-iodine and powdered antibiotic combination: early experience from a tertiary centre

Purpose

The aim of the study was to evaluate topical povidone-iodine and topical powdered antibiotic combination (Polymyxin, Bacitracin and Neomycin) in initial non-operative management with delayed closure of the defect of giant omphaloceles.

Methods

A prospective study was conducted between July 2010 and June 2013 including all neonates with giant omphalocele without signs of intestinal obstruction. All cases were managed by daily application of povidone-iodine (5 % solution) followed by spraying topical powdered antibiotic combination to promote eschar formation and eventual epithelialisation. Record was made of sex, associated anomalies, length of stay, and thyroid function tests.

Results

Twenty-four neonates with giant omphaloceles were treated with topical povidone-iodine and topical powdered antibiotic combination. No sac ruptures were observed in our series. All patients had a normal thyroid function test at presentation and after 10 days of initiation of treatment. Six patients have undergone delayed repair.

Conclusion

Topical povidone-iodine and powdered antibiotic combination promotes more rapid escharification and epithelialisation of the omphalocele than povidone-iodine alone. We also hypothesise that combination minimises the chances of hypothyroidism associated with use of povidone-iodine alone.     

Nonsurgical (conservative) treatment of giant omphalocele. A report of 10 cases

Between January 1970 and December 1984, 65 patients with a congenital anterior abdominal wall defect were admitted to the Pediatric Surgical Center of the St. Radbound Hospital, Nijmegen, The Netherlands. There were 39 cases of omphalocele. Ten had giant omphalocele, defined as omphalocele that could not be closed primarily. In these cases, a conservative method of treatment was used. The results are reported of these 10 cases of giant omphalocele with special emphasis on mortality, complications, and length of hospital stay. Mean hospital stay was 95 days. Local infection did not present serious problems. Sepsis occurred in half the patients but was managed with antibiotics. There was one case of late volvulus of the stomach. All local applications, if used regularly, gave rise to complications. Two cases of hypothyroidism caused by the application of povidon-iodine and one case of alcohol intoxication were observed. In early years, one child was lost due to mercury poisoning. There was one early and one late death unrelated to the procedure.     

Abdominal wall defects in the era of prenatal diagnosis

In order to study the effects of prenatal diagnosis, we reviewed all 141 cases of abdominal wall defects (AWD) seen in our institution since 1980. In the period up to the end of 1994, 65 AWDs were diagnosed at the Department of Obstetric Ultrasound and another 76 infants were born with an AWD, 44 with omphalocele (prenatal diagnosis 29), 21 with a cord hernia (prenatal diagnosis 4), and 76 with gastroschisis (prenatal diagnosis 32). In the prenatal diagnosis group the frequency of cesarean section was 48%, in the postnatal diagnosis group 13%. In the omphalocele group, the pregnancy was terminated in 12 cases and there were 10 intrauterine deaths. A further 10 babies died in the first days of life, so that only 12 came to operation; 6 survived. At least 27 of the 44 infants had other severe anomalies. Omphalocele has a poor prognosis that is not improved by prenatal diagnosis, so that termination is a reasonable option. In the cord hernia group 1 patient died because of a cardiac anomaly; all the others had primary closure without complications. In the gastroschisis group, the pregnancy was terminated in 7 cases and there were 2 intrauterine and 2 neonatal deaths. Sixty-five infants were operated upon immediately after birth, 50 (77%) with primary closure and 15 in two stages. Four died after primary closure (8%) and 4 after a silastic silo (27%). The overall mortality was 12.3%. Postoperative intestinal morbidity was assessed by the period until total enteral nutrition could be established, which was from 8 to 185 days (median 17 days). The unfavorable prognostic factors were intestinal thickening and staged closure. Neither prenatal diagnosis nor mode of delivery could be shown to have any effect on mortality or morbidity.