先天性腹裂的临床回顾性研究

目的 归纳总结先天性腹裂的治疗效果及体会,展望今后的临床研究方向.方法 回顾上海新华医院、上海儿童医学中心1996年12月至2007年7月收治的23例腹裂患儿,分析其治疗效果,并分别比较低出生体重儿和正常出生体重儿、顺产儿和剖腹产儿的治疗效果.结果 Ⅰ期关腹治疗3例,治愈2例;免缝Silo袋分期修复14例,治愈12例;只放置Silo袋、但后来死亡或放弃治疗4例;未经任何治疗自动出院2例.该病的总治愈率为60.9%(14/23),病死率为13.0%(3/23),放弃治疗者占26.1%(6/23).低出生体重儿和正常出生体重儿、顺产儿和剖腹产儿的治疗效果差异无统计学意义(P＞0.05).结论 腹裂的治愈率仍有待提高.对难以Ⅰ期关腹的腹裂患儿,床边非麻醉下放置免缝Silo袋、Ⅱ期手术修复是一种安全可靠、操作简便的治疗方式.出生体重和分娩方式未对治疗效果造成影响.

Retrospective study of congenital gastroschisis

Objective To summarize the outcome of gastroschisis in our hospital and prospect for the further clinical research.Methods The medical records of gastroschisis in Xinhua Hospital and Shanghai Children's Medical Center between December 1996 and July 2007 were reviewed.Therapeutic outcomes were analyzed,and were compared according to birth weight and mode of delivery.Results There were 23 gastroschisis patients.Three underwent primary closure(2 successful)and 14 were managed by Silo staged repair(12 successful).Four patients started with Silo bag.They were deceased or self-discharged against medical advice during the bowel reduction.Two patients were discharged without any management.The healing rate was 60.9%(14/23)and the mortality rate was 13.0%(3/23).Twenty-six percent(6/23)were discharged against advice.There was no statistical difference of outcome between babies born with low birth weight and normal birth weight and babies delivered by normal labor and Cesarean(P＞0.05).Conclusions The management of gastroschisis needs tO be improved.For patients who can't be managed by primary closure,it is safe to place a sutureless Silo bag at the bedside without anaesthesia and perform a staged closure.Birth weight and delivery mode do not influence the therapeutic outcome.