自体脐带片修补先天性腹裂

目的　报告用新生儿自体保留的脐带做成脐带片 ,修补先天性腹裂的临床观察。方法　自 1995年 5月～ 2 0 0 0年 6月 ,用自体脐带片修补新生儿腹裂 6例 ,患儿入院后立即清洗消毒 ,根据保留脐带的大小分别获得 3.0～ 3.5cm× 5 .0～ 8.0cm大小的脐带片 ,保留左侧基部 ,右侧脐片与裂开的腹壁边缘间断缝合。结果　 1例术后第 4周发生肠粘连、肠梗阻 ,家长放弃再手术而死亡 ,5例治愈出院。随访 4例 ,随访时间 3个月～ 3年 ,3例上皮覆盖后无切口疝 ,1例遗留小型腹壁疝 ,待Ⅱ期修补。患儿营养发育良好。结论　自体脐带片是患儿自身的生物活性组织 ,无毒性 ,无抗原性 ,并具有一定的弹性 ,修补腹裂后 ,能有效的减轻腹腔压力 ,并且取材容易     

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。     

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。     

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。     

620例极低出生体重儿的临床资料分析

目的 探讨影响极低出生体重儿存活率的相关因素，为降低其死亡率提供帮助。方法 对笔者医院近10年收治的620例极低出生体重儿按体重分三组，并对其临床资料进行回顾性分析。按住院年份（1991－1995年和1996－2000年）分两组，对其生存和死亡进行分析比较。结果 极低出生体重儿主要原因有多胎妊娠（27．3％）、羊膜早破（20．2％）、妊娠并发症（11．5％）和原因不明（36．8％）。所有住院患儿均有一种或一种以上并发症，主要有呼吸暂停384例（61．9％）、低体漫画348例（56．1％）、脑室同出血260例（41．9％）、呼吸窘迫综合征222例（35．85）和动脉导管开放168例（27．1％）、感染162例926．1％）。体重越低，并发症的发生率越高。本组极低出生体重儿存活率86．5％，体重≤1000g存活率为60．6％。前后5年两组比较，近5年存活率明显提高（80．8％比89．2％，P＜0．005）。死亡的主要原因是呼吸窘迫综合征、感染和脑室内出血。结论 极低出生体重儿必须收贪婪NICU病房密切监护；早期发现并发症，及时处理；防止院内感染。对呼吸道窘迫综合征采用表面活性物质和高频通气治疗可以提高极低出生体重儿的存活率。     

先天性腹裂外科治疗的麻醉体会

目的总结新生儿先天性腹裂修补术的麻醉体会。方法回顾性分析23例新生儿先天性腹裂修补术的麻醉过程。结果3例采用全麻后Ⅰ期关腹直接复位缝合术，14例先采用非麻醉下免缝Silo袋Ⅰ期免缝手术，5～7d后在气管插管全麻下行Ⅱ期复位缝合术，只放置Silo袋、后期死亡或放弃治疗4例；未经任何治疗自动出院2例。手术患儿中12例麻醉过程较平稳，5例术中血压轻度下降，经加快输血输液等处理后血压回升，无麻醉死亡，均顺利完成手术。术后死亡3例，1例死于多脏器功能衰竭，2例术后肺膨胀不良死于呼吸衰竭。随访时间4个月至4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，新生儿先天性腹裂复位修补术的围手术处理关键是麻醉保障，而麻醉的重点是气道管理和保证循环功能稳定。     

Ⅰ期无缝合肠管还纳术治疗先天性腹裂

目的 总结Ⅰ期无缝合肠管还纳术治疗先天性腹裂的经验和体会.方法 回顾性分析2007年12月至2011年8月收治的24例先天性腹裂患儿资料,15例采用气管内麻醉下Ⅰ期无缝合肠管还纳术,9例采用人工囊袋分期修复术.将两组患儿的术后进食时间及住院时间进行对比.结果 Ⅰ期无缝合组治愈13例,1例因双肾发育不良放弃,1例因硬肿症死亡;分期组9例全部治愈出院,分期组患儿的术后进食时间及住院时间明显长于Ⅰ期无缝合组.结论 采用气管内麻醉下实施Ⅰ期无缝合肠管还纳修复术,有条件地扩大了Ⅰ期无缝合肠管还纳修复方法治疗的适应证,使更多的先天性腹裂患儿免受二次手术打击,而且口服喂养时间明显提前,缩短了住院时间,也就减少了住院费用,是一种安全可靠且美容的方法.     

先天性腹裂并胃穿孔、小肠闭锁一例

患儿：男，G1P1，足月顺产，在家庭自行接生，生后即发现患儿腹壁裂开，大量肠管外露，脐带未断，带胎盘急诊入院。入院检查：T35．5℃．P169次／min，R：41次／min，体重2．4kg。一般情况差，心肺均无阳性体征发现。腹壁正中裂开，长约6cm，胃、部分小肠及结肠脱出于腹壁外，小肠与结肠有共同系膜，表面沾有粘液及纸屑等污染物，胃前壁小弯侧有一直径3cm穿孔，胃壁肌层发育差，有黄绿色胃液流出，脐带未断，与腹壁裂口边缘附着。     

胎兔膈疝模型的制作及人工腹裂对肺发育的影响

目的胎兔膈疝模型进行孕期人工腹裂操作，探讨先天性膈疝宫内减压扩肺治疗的价值。方法新西兰孕兔32只，其中21只孕23d，双角子宫一侧末梢胚胎行膈疝造模，另一侧假手术作对照；另11只孕兔，子宫双侧末梢胚胎孕23d均手术造模，孕26d再次剖宫，一侧膈疝兔进行人工腹裂，另一侧仅打开羊膜腔，共得4组胎兔：假手术组（CR组）、膈疝组（DH组）、膈疝无腹裂组（CGS组）、膈疝合并腹裂组（GS组）。分别进行肝、肺重量及轴向腺泡计数（RAC）、终末支气管密度（MTBD）、肺泡相应区域面积（S%）、肺小动脉中膜厚度百分比（MT％）等病理学指标检测。结果①CR组肺湿重／体重（Lw／Bw）为（0．0262±0．005）、RAC（3．17±1．00）个、MTBD（3．42±1．20）个、S％（58．12±11．80）％。DH组和CGS组较CR组Lw／Bw、RAC、S%均明显减少，MTBD、MT％增加。GS组肺发育各项指标和MT％与DH组、CGS组比较无显著差异；②GS组、DH组、CGS组中肝脏重量／体重（Hw／Bw）相对CR组明显增加（P〈0．05），Hw／Bw与Lw／Bw比呈一定负性关系，但未能显示统计学上差异（R=0．2，Y=0．0513X＋0.024）。结论胎兔膈疝模型存在肺发育不良，人工腹裂不能改善肺发育不良，肝脏的主动长入是肺受压的主要因素。     

分期修复术治疗腹裂5例

探讨用硅塑囊分期修复术治疗腹裂的临床疗效。方法分析应用硅塑囊分期修复术治疗新生儿腹裂５例的临床塑料。结果５例新生儿腹裂全部存活,术后随诊满意。结论应用硅塑囊分期修复术治疗新生儿腹裂是一种简单,安全有效的方法,有临床应用价值。     

Are babies with gastroschisis small for gestational age?

A large proportion of babies with gastroschisis (GS) have low birth weights. It is not clear, however, whether only certain subgroups or the whole population of babies with GS have low birth weights. The aim of this study was to ascertain if the birth weights of babies with GS are significantly lower than those of the general population and to determine if the birth weights of babies with GS from two different populations were significantly different. From 1969 to 1995, 44 babies with GS were treated at Auckland Children's Hospital, New Zealand. From 1980 to 1993, 69 babies were treated at Birmingham Children's Hospital, England. For each group, the mean birth weight relative to the mean birth weight for gestation (WtStdev) was significantly different from zero (Auckland = –0.806, Birmingham = –0.762,P < 0.001, one-sample analysis). The mean WtStdev scores from each centre were not significantly different from each other. Our data demonstrate that the birth weights of babies with GS are significantly lower than those of the general population and are similar in different populations. These findings support the notion that a normally functioning intestinal tract is essential for normal fetal growth.     

Non-operative management of gastroschisis: a case-matched study

Non-operative management of gastroschisis also known as plastic closure (PC) has been described as an alternative to conventional primary operative closure (POC) or staged silo closure (SSC). The aim of this study was to compare these techniques in neonates with gastroschisis. A retrospective review of neonates with gastroschisis who underwent PC was undertaken. The minimum follow-up was 1 year. Premature neonates (<35 weeks) and those with intestinal atresia or multiple congenital anomalies were excluded. Frequency matching of PC cases with two control groups with either POC or SSC was performed on 1:1 ratio, based on gestational age and birth weight. Statistical analysis using univariate analysis was performed. Three groups were assembled: PC, POC and SSC (n = 33). Median follow-up was 1,198 days. Groups were comparable with regard to: time to first feed, time to full enteral feeding, frequency of vascular access related infections, ventilation time, NICU LOS (length of stay) and hospital LOS. There was no difference observed in surgical complications. Almost all neonates in the PC group developed an umbilical hernia (83.8%). Umbilical hernias were highly associated with PC compared to the other two groups P = 0.001. To date only one patient has had to have an operative repair of the umbilical hernia in the PC group. Plastic closure is safe and comparable to conventional closure techniques. However, PC is associated with the development of more umbilical hernias. The natural history of these hernias remains to be defined.     

应用免缝SILO袋分期治疗新生儿腹裂临床研究

目的　介绍应用免缝SILO袋分期治疗新生儿腹裂。方法　收集芝加哥大学儿童医院 1998年 1月至2 0 0 2年 7月应用免缝SILO袋分期治疗 15例腹裂患儿。患儿体重 2 1～ 3 5kg ,根据腹壁缺损大小选择环口直径 3～ 5cm的SILO袋。脏器回纳腹腔后择期关闭腹壁。结果　 15例患儿全部顺利分期关闭腹壁缺损。 2例 (13 3% )SILO袋在使用中滑出腹壁 ,立即于床边重新放置SILO袋。SILO袋平均使用天数为 3 7d ,完全经口进食平均为2 2d。 1例患儿伴有小肠闭锁做肠吻合后再安置SILO袋。随访 3个月至 4年 ,15例全部存活。结论　应用免缝SILO袋分期关闭腹壁缺损是一种安全、可靠、有效的方法。     

The impact of iatrogenic gastroschisis on pulmonary maturation in the fetal rabbit models of congenital diaphragmatic hernia

Purpose  The aim of this study was to analyze the effect of iatrogenic gastroschisis on pulmonary hypoplasia in fetal rabbits with congenital diaphragmatic hernia (CDH). Materials and methods  A total of 30 pregnant rabbits received fetal surgery on gestational day 23. A left diaphragmatic hernia was created in one end fetus (DH group) of each rabbit, and the other end fetus of the same rabbit received sham thoracotomy as control (CR group). Another 19 pregnant rabbits underwent partial resection of the diaphragm in both end fetuses on gestational day 23, and then artificial gastroschisis was performed on one end fetus (GS group) on gestational day 26, while the other end remained as control (CGS group). The fetuses were harvested on gestational day 30. The histological and morphometric evaluation of lungs and livers of the end fetuses in each group was conducted. Results  In the DH group, the lungs were hypoplastic with a decrease in the total lung weight to body weight ratio, and remarkable thickening in alveolar septa. The lung vessels showed significantly thicker arterial walls when compared with those from control fetuses. The pathological finding in the CGS group was similar to that of the DH group. The thickness of the alveolar septa and of the pulmonary arterial walls showed no significant difference among the GS group, DH group and the CGS group. The ratio of liver weight to body weight increased notably in the GS group, DH group and CGS group compared with that in the CR group. Conclusions  In the fetal rabbit models of CDH, pulmonary hypoplasia is the most significant pathological feature. Iatrogenic gastroschisis does not improve pulmonary maturation due to the active growth of the liver that herniates into the thoracic cavity.     

Influence of birthplace on gastroschisis outcomes in a state in the southeastern region of Brazil

ObjectiveTo characterize the influence of birthplace on outcomes of patients with gastroschisis admitted to three hospitals in a state in Brazil’s southeastern region, according to condition inborn (born in a reference center) or outborn (born outside the reference center).MethodsRetrospective multicenter cohort study of patients with gastroschisis. The sample size utilized was of patients admitted in three hospitals with a diagnosis of gastroschisis ICD 10 Q79.3 between January 2000 to December 2018. Patients were divided into two groups, inborn and outborn. Characteristics of prenatal, perinatal and postoperative were compared using statistical tests. The level of significance adopted was P-value < 0.05.ResultsIn total, 144 cases of gastroschisis were investigated. The outborn patients group had higher rates of absence of antenatal diagnosis (p = 0.001), vaginal delivery (p = 0.001), longer time between birth and abdominal wall closure surgery (p = 0.001), to silo removal (p = 0.001), to first enteral feeding (p = 0.008), for weaning from mechanical ventilation (p = 0.034), used less peripherally inserted central catheter (PICC) and required more venous dissections (p = 0.001), and lower mean of serum sodium (p = 0.015). There were no differences in mortality rates and length of hospital stay between the inborn and outborn groups.ConclusionAlthough outborn patients with gastroschisis were less likely to have an antenatal diagnosis and were more prone to a longer time to undergo surgical and feeding procedures, and to spend more time in mechanical ventilation, these disadvantages seemed not to reflect on the death rate and the length of hospital stay of patients from this group.