新生儿含肝组织的巨型脐膨出的临床治疗抉择探讨

目的:回顾分析含有肝脏组织的巨型脐膨出(GO)的临床特征，探讨最佳治疗方式，改善预后，提高GO患儿救治率。方法:收集2009年1月至2019年5月在武汉儿童医院新生儿外科住院的GO患儿，治疗方法包括：1.使用类似Silo袋的方法，分期手术；2.一期直接或联合补片修补；3.保守治疗2～8周后延期一期手术。收集的数据包括患...

Investigation of proper treatment for giant omphalocele with liver protrusion in neonates

Objective To investigate the proper choice and improve the survival rate in neonates suffering from giant omphalocele(GO)with liver protrusion by analyzing the clinical characteristics,different treatments and outcomes.Methods Neonates with GO admitted in Department of Neonatal Surgery in Wuhan Children′s Hospital were retrospected from January 2009 to May 2019.The treatment methods include:(1)repaired with similar silo-bag by staged operation;(2)one-stage repair with patch or not;(3)delayed repair by conservative treatment for some time(from 2 to 8 weeks)firstly.Data included gestational age,gender,birth weight,average diameter of omphalocele,contents of omphalocele,associated malformation,treatment method,duration of ventilator use and clinical outcome.These neonates were divided into 2 groups according to the contents of protrusion:group with liver protrusion and group with liver and other organs protrusion.Clinical data were summarized and compared between different groups.Results Sixteen cases were collected,including 9 males and 7 females.The average age was(1.25±0.45)d(1-2 days),the average birth weight was(2.48±0.37)kg,and pregnant week was(36.23±1.17)weeks.The average diameter of the omphalocele was(9.88±3.30)cm,ranging from 5 cm to 15 cm.Seven cases were belonged to the group with liver protrusion,cases undergone one-stage repair,delayed repair were 6 cases and 1 case,respectively.There were 9 cases in group with liver and other organs protrusion,and the protruded organs included liver,intestine,colon or spleen.Among them,cases needed one-stage repair,delayed repair and silo-bag repair were 3 cases,3 cases,3 cases,respectively.Cases needed respiratory machine were 3 cases(42.8%)and 8 cases(88.89%)in group with liver protrusion and group with liver and other organs protrusion,respectively.Neonates had a longer time of needing respiratory machine in group with liver protrusion,comparing with the neonates in group with liver and other organs protrusion[(30.67±19.0)h vs.(106.25±69.36)h,P=0.021],and the risk rate to use respiratory machine was 5.143(95%CI:0.727-36.368).There were no dead cases in group with liver protrusion.Three cases were dead in group with liver and other organs protrusion.All the patients were followed from 3 months to 4 years,and hernia in abdominal wall was found in 5 cases,including 1 case in group with liver protrusion and 4 cases in group with liver and other organs protrusion.If the dead cases had been excluded,the rate of hernia was 66.7%(4/6 cases)in group with liver and other organs protrusion.Conclusions Individual treatment should be emphasized in neonates suffering from GO with liver protrusion.Neonates with single liver protrusion have a better prognosis than those with liver and other organs protrusion.One-stage repair is recommended in the former,and the delayed repair is highly recommended in the latter.The accessory liver should be considered when GO neonates presenting liver protrusion.