小肠黏膜下层生物补片在腹裂修补术中的应用

目的 探讨小肠黏膜下层生物补片在腹裂修补术中的作用.方法 2010年6月至2015年5月,我们对20例腹裂患儿采用生物补片进行修复,其中12例采用小肠黏膜下层(SIS)生物补片一期修补腹壁缺损(SIS组),8例采用脱细胞真皮生物补片一期修补腹壁缺损(真皮组),与2006年6月至2010年5月收治的14例未用任何组织替代物、强行一期修补的腹裂患儿(对照组)的临床资料进行比较,观察胎龄、出生体重、出生至手术时间、缺损大小、暴露于腹腔外脏器情况、术后机械通气情况、术后开始进食时间、住院时间、切口感染、腹壁疝的发生率等指标.结果 三组患儿平均胎龄、出生体重、出生至手术时间、缺损大小、腹腔脏器脱出情况之间差异无统计学意义;SIS组12例患儿中仅2例患儿术后需机械通气,平均通气时间24 h,真皮组2例患儿需机械通气,平均通气时间19h,对照组10例患儿需机械通气,平均机械通气时间39 h,补片组机械通气的必要性和通气时长显著低于对照组,补片组中SIS组和真皮组机械通气的必要性和通气时长差异无统计学意义;SIS组和真皮组术后的开始进食时间分别是(186.5±37.7)h、(173.3±41.5)h,显著少于对照组开始进食时间(256.1±41.8)h;SIS组和真皮组的住院时间分别是(16.2±3.0)d、(15.1±2.2)d,显著少于对照组的住院时间(19.4±3.6)d;SIS组术后无切口感染发生,有2例术后3个月发生切口疝,1年后自行愈合,无需再次手术修补;真皮组术后3例发生切口感染、排异反应,经伤口换药、去除补片后瘢痕愈合,有2例术后5个月发生切口疝,2例约1年后逐渐自行愈合,无需再次手术修补;对照组5例发生切口感染,经换药后好转,3例切口裂开,蝶形胶布固定换药后瘢痕愈合,5例术后3个月发生切口疝,3例1年后逐渐愈合,2例2年后未愈合施行手术修补.结论 对腹壁缺损大、腹腔容积小的腹裂患儿可以采用一期补片修复的方式,以减少分期手术率、术后机械通气,降低术后腹腔压力,有利于肠道功能恢复;小肠黏膜下层(SIS)和脱细胞真皮组织补片均能用于修复腹壁缺损,但小肠黏膜下层在生物相容性、抗感染等方面优于脱细胞真皮组织.

Application of small intestinal submucosal biological patch in repair or neoplasty of gastroschisis

Objective To explore the application of small intestinal submucosa (SIS) biological patch in repair or neoplasty of gastroschisis.Methods From June 2010 to May 2015,20 patients with gastroschisis underwent primary repairing of abdominal defect.They were divided into two groups of submucosal biological patch (SIS,n =12) and acellular dermis biological patch (dermal,n =8).And another 14 patients without any tissue substitution were selected as controls from June 2006 to May 2010.The clinical data of gestational age,birth weight,operative duration,defect size,exposure to abdominal organs,postoperative mechanical ventilation,time for postoperative dieting,days of hospital stay,postoperative incision infection and incidence of abdominal hernia were compared among three groups.Results No statistical difference existed in average gestational age,birth weight,operative duration,defect size or exposure to abdominal organs among three groups.Two cases each of SIS and dermal groups required mechanical ventilation.The average ventilation time was 24 and 19 hours respectively.And 10 cases in control group received mechanical ventilation with an average time of 39 hours.The necessity and time of mechanical ventilation were significantly lower in patch group than those in control group.No significant difference existed between SIS and dermal groups.Time for postoperative dieting and days of hospital stay were (186.5 ± 37.7) hours,(16.2 ± 3.0) days and (173.3± 41.5) hours,(15.1 ± 2.2) days in SIS and dermal groups respectively.They were significantly lower than those of control group (256.1 ± 41.8) hours and (19.4 ± 3.6) days.Two cases of incision hernia at 3 months recovered after 1 year.There was no surgical repair in SIS group without any postoperative incision infection.Three cases of postoperative incision infection and rejection healed after wound dressing and patch removal.Another two cases of postoperative incision hernia at 5 months recovered gradually after 1 year.There was no surgical repair in dermal group.Five cases of incision inflammation improved after dressing.Three cases healed after butterfly fabric fixation.Among 5 cases of postoperative incision hernia at 3 months,3 cases recovered gradually after 1 year and two were repaired after 2 years.Conclusions One-staged patch repair is recommended for gastroschisis patients with large abdominal defect and small abdominal cavity.Both SIS and acellular dermis biological patch can be used for repairing abdominal defect.However,SIS offers better profiles of biocompatibility and anti-infection.