新生儿先天性腹裂10例

腹裂是新生儿期严重的腹壁发育畸形。我院于 1994～2 0 0 2年 12月共收治 10例 ,存活 7例 ,现总结报告如下。临床资料一、一般资料　本组 10例 ,男 7例 ,女 3例 ;孕龄 35～ 39周 ,出生体重 2 .0～ 3.0kg ,日龄 1～ 14h ,平均 8h。 6例可见小肠、结肠暴露在腹壁外 ,4例可见胃、小肠、结肠脱出腹腔。8例入院时已排胎便 ,2例肛诊时排出。腹裂均位于脐右侧 ,裂口 3～ 5cm ,4例外院转入 ,6例本院产科出生 ,其中 3例保留脐带 10～ 2 5cm。二、手术方法　均急诊手术。采用气管内插管麻醉。温消毒液彻底冲洗暴露肠管 ,消毒周围皮肤 ,检查肠管有无闭…     

应用自体脐带修补腹裂及术后远期观察

目的 探讨腹裂的手术方式，提高其治愈率。方法 应用婴儿自体脐带作补片修补腹裂。结果 8例中成活6例，2例死于硬肿症或颅内出血，与手术无关，成活6例生长发育良好。结论 该手术取材方便，有效地增大腹腔容积和缓冲了腹内压力，术后不需辅助呼吸，自体脐片有利于切口愈合。     

生物组织补片修补先天性腹裂9例

目的：总结采用同种异体脱细胞生物组织补片整复、修补先天性腹裂的治疗经验。方法回顾性的分析自2010年以来采用同种异体脱细胞生物组织补片修补的新生儿先天性腹裂9例患儿的临床资料。患儿入院后尽快送入手术室,以温生理盐水及温碘伏仔细冲洗并还纳脱出的腹腔内容物后,将生物组织补片与除皮肤外的腹壁创口边缘全层间断缝合。术后送SICU监护。3例患儿未行呼吸机支持治疗,6例患儿分别行呼吸机支持治疗1～2d。结果9例患儿术后恢复顺利,切口愈合好,无红肿渗液,痊愈出院。随访6月～3年,其中7例腹壁缺损已完全愈合,2例留有小型腹壁疝,待二次手术修补,患儿营养发育与同龄儿无明显差别。结论腹裂手术的原则是回纳疝出脏器,关闭腹壁筋膜及皮肤。但由于腹壁缺损大,需要采取分期手术或延迟手术。生物组织补片其细胞毒性小,生物相容性好,无明显致敏性及排斥反应,修补腹裂后,能有效的减轻腹腔压力,可以一期完成手术,适用于先天性腹裂的治疗。     

先天性腹裂伴胃壁肌层缺损一例

患儿 :男 ,出生后 3ｈ。因腹壁裂开 ,肠管外露 ,于 2 0 0 2年 2月 11日入院。入院检查 :一般情况尚好 ,无发热及体温不升等 ,胎便未解 ,小便正常 ,无咳喘。体检 :体重 4 .0ｋｇ,营养中等 ,精神萎糜 ,两肺呼吸音粗。腹壁正中裂开 ,长约 6ｃｍ ,部分回肠及结肠脱出于腹壁外 ,长约 8 0ｃｍ ,小肠与结肠有共同系膜 ,表面有少量渗液。治疗 :立即补液及抗感染等治疗 ,并于当天手术。稍扩大腹壁裂口 ,将外露肠管回纳入腹腔 ,修剪切缘成新鲜创面 ,全层减张缝合关腹。术后置恒温箱 ,补液、抗感染及支持治疗。术后 3ｄ出现腹胀 ,进行性加重 ,阴囊水肿…     

先天性腹裂分期修复术14例诊治分析

目的 探讨先天性腹裂的治疗方法。方法 对14例先天性腹裂的诊疗情况进行回顾性研究分析，结果 14例先天性腹裂手术患儿中，10例存活，4例死亡。10例存活患儿8例获3月。5年随访，发育基本正常。结论 先天性腹裂是一种严重的先天性畸形，合理的手术方式、呼吸系统支持、全胃肠道外营养、预防及正确处理并发症是治疗成功的关键。     

先天性腹裂的诊疗体会

目的总结先天性腹裂患儿的治疗经验。方法回顾性分析21例新生儿先天性腹裂患儿的病例资料。19例采用传统全麻插管下I期复位缝合术,2例采用非全麻气管插管下I期免缝手术。结果19例全麻气管插管I期复位缝合术的患儿中,治愈18例,死亡1例,死亡原因为坏死性小肠结肠炎、多器官功能衰竭。2例非全麻气管插管下I期免缝手术患儿均痊愈出院。所有存活患儿均获随访,随访时间3个月至7年,患儿均生长发育正常。结论手术是治疗先天性腹裂的主要方法,产前诊断为产房手术提供了可能,妥善的围手术期处理是手术成功的保障。     

先天性腹裂治疗方式20年系统评价

目的客观呈现20年来一期手术关腹和Silo技术分期修复治疗的先天性腹裂患儿存活情况。方法检索相关数据库,对两种方法治疗的腹裂患儿的存活率进行Meta分析,比较其差异。结果Meta分析显示,1988—2007年一期关腹组术后存活率高于Silo分期修复组,敏感性分析结果与之一致。亚组分析显示,1988。1997年两组存活率差异无统计学意义,1998。2007年一期关腹组存活率高于Silo分期修复组。结论1988—2007年一期手术关腹患儿术后存活率高于Silo技术分期修复。由于病例分组存在选择偏倚,难以得出一期关腹效果优于Silo技术分期修复的结论。     

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.     

Ⅰ期无缝合肠管回纳法治疗先天性腹裂

目的总结分析先天性腹裂非全麻插管Ⅰ期无缝合肠管回纳法治疗经验。方法回顾性分析2004年1月～2005年12月复旦大学附属儿科医院新生儿腹裂10例，分为全麻插管Ⅰ期或分期手术修补组（简称手术组）及非全麻插管Ⅰ期无缝合肠管回纳治疗组（简称非手术组）。比较胎龄、出生体重、出生至手术时间、静脉营养时间、术后开始进食时间、全胃肠喂养开始时间、住院时间及住院总费用。结果10例腹裂中5例为手术组，5例非手术组。平均胎龄两组无统计学差异，非手术组平均出生体重明显较高（P〈0．05）。出生至手术时间手术组均超过9h，最长23h；非手术组平均6．1h，仅1例为12h。非手术组术后均不需要气管插管和辅助呼吸，手术组需23-72h呼吸机支持。非手术组全静脉营养时间明显短于手术组（P〈0．01）；术后开始进食时间和全胃肠喂养开始时间亦明显短于手术组；住院时间和住院总费用也有显著改善。结论非全麻插管Ⅰ期无缝合肠管回纳治疗新生儿腹裂，避免了机械通气，明显提早口服喂养和出院时间，减少治疗费用，取得了很好的疗效。     

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.     

End-results of experimental gastroschisis created by abdominal wall versus umbilical cord defect

An experimental study was conducted to determine the end-results of two different defects on the anterior abdominal wall: an abdominal wall defect (AWD) versus an umbilical cord defect (UCD) using chick embryos. The AWD was created by leaving an intact skin bridge between the defect and the umbilical cord in group l; the UCD was created on the umbilical cord near the junction of the skin in group 2. At the end of incubation, the intestines appeared hemorrhagic in the AWD group, but not in the UCD group. During microscopic examination, hemorrhagic areas were observed in the bowel wall and mucosal villi in the AWD group but not in the UCD group. The end-result of the defect causing the physiological umbilical hernia resulted in bowel damage resembling the classic picture of gastroschisis (GS). We conclude that the site of the defect in GS is not the abdominal wall itself, but the physiological umbilical hernia.     

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.     

The time of separation of the umbilical cord

The time of separation of the umbilical cord was studied in 911 neonates. The mean time of separation was 7.4 days (SD 3.3, range 1–29 days). We sought a possible relationship between the time of cord separation and various factors in the perinatal period. Cord separation was delayed when antibiotics needed to be administered to the neonate because of sepsis, when the infant was born prematurely, delivered by Caesarean section or had a low birth weight. The cord separated slightly earlier in female than in male infants. None of the infannts studied suffered from omphalitis and it would appear that delayed separation of the cord is not always necessarily accompanied by severe leucocyte dysfunction.     

脐带悬吊延期修补治疗巨型脐膨出

目的 探讨脐带悬吊延期修补腹壁缺损治疗巨型脐膨出的临床效果.方法 设计脐带悬吊囊膜、逐渐收紧囊膜还纳膨出内脏器官的方法治疗10例巨型脐膨出,对其治疗过程和临床效果作回顾性总结.结果10例开始悬吊的平均日龄1 d(1～2 d),悬吊平均时间21.7 d(15～37 d).10例均一次手术修补缺损,2例同时行Ladd术.术后2例出现腹壁切口疝,1例出现呼吸困难,行呼吸机辅助通气3d后好转.术后开始进食时间3 d(2～6 d),正常喂养进食平均时间7 d(5～10 d).结论脐带悬吊延期修补治疗巨型脐膨出具有治疗简单、经济、一次手术完成,同时具有Silo袋法及保守疗法的优点,临床效果较好.     

The Roach muscle bundle and umbilical cord coiling

OBJECTIVE: To determine if presence of the Roach muscle, a small muscle bundle lying just beside the umbilical artery, contributes to umbilical cord coiling. METHODS: 251 umbilical cords were examined. The umbilical coiling index (UCI) was calculated as the number of coils divided by the cord length in cm. Cords were classified as hypocoiled (UCIp90). On microscopic examination of a cross section of the cord, absence or presence of a Roach muscle was determined. The t-test for independent samples and logistic regression were used for statistical analysis. RESULTS: A Roach muscle was observed in 101 cords. The mean UCI was higher in cords with the muscle bundle (0.23 coils/cm) than in cords without a muscle (0.18 coils/cm). Difference in mean: 0.05 coils/cm (95% C.I. 0.01-0.09). OR for hypercoiling in presence of the muscle was 2.98 (95% C.I. 1.57-5.64). OR for hypocoiling in the presence of the muscle was 1.49 (95% C.I. 0.79-2.81). CONCLUSIONS: Our results suggest that presence of a Roach muscle bundle contributes to umbilical cord coiling. Given the divergence in umbilical cord coiling within subgroups with or without this muscle, other factors must play a more dominant role.     

Intussusception as a late morbidity after gastroschisis repair

A 4-month-old boy presented with intussusception following primary closure of a gastroschisis as a neonate. Hydrostatic reduction of the intussusception was successful. After the reduction an ileus persisted for several days, but was successfully managed conservatively. As far as we know, this is the first report of a gastroschisis patient developing an intussusception. The diagnosis of intussusception per se was not difficult, but itwas difficult to rule out a midgut volvulus, which would have required an urgent laparotomy.Presented at the New Zealand Annual Scientific Meeting of Royal Australasian College of Surgeons, Palmerston North, August 10, 1994     

影响足月新生儿脐带脱落时间相关因素的研究

目的：分析影响足月新生儿脐带脱落时间的相关因素。方法：观察337例足月新生儿脐带脱落时间,并对性别、胎龄、体重、脐带结扎位置、脐残端长度、脐带直径、脐带贴卫生、医护人员及家属手卫生、脐部感染等14项相关因素进行单因素分析和多因素非条件logistic回归分析。结果：单因素相关分析发现脐带结扎位置、脐残端长度、脐带直径、脐带贴卫生、脐部感染对脱脐时间有影响（P<0.05）。其中脐带结扎位置、脐残端长度、脐带贴卫生、脐部感染是影响新生儿脐带脱落时间主要因素。结论：脐带结扎位置<0.5 cm、脐带残端保留<0.5 cm、保持脐带贴卫生、预防脐部感染有助于脐带尽早脱落。［中国当代儿科杂志,2010,12(11)：867-869］     

Use of amniotic grafts in the repair of gastroschisis

This article describes the use of amniotic grafts (AG) in the repair of large abdominal wall defects in newborns with gastroschisis. From 1988 to 1995, 22 newborns with gastroschisis underwent surgical repair. In 12 primary closure (PC) was performed; in 10 the abdominal wall defect was covered with an AG. A double layer of AG was used and the graft was additionally covered with a silastic silo in 8 cases. The overall mortality was 14%; 3 children died from necrotizing enterocolitis or sepsis after AG. However, the difference in mortality of newborns with PC versus AG was not statistically significant. Patient characteristics, the postoperative courses, nd the frequency of complications were similar after PC and AG. It is concluded that AG has no negative impact on the postoperative course and yields a low overall mortality. In our opinion there are several advantages in using the AG technique: it is an autoplastic material that is readily available without costs, reefing and removal is unnecessary, and there is a potentially low rate of adhesions.