新生儿外科畸形的早期综合干预

目的通过产房外科等早期综合干预以提高新生儿外科畸形的临床诊治水平。方法对20例产前超声检查存在异常表现的胎儿进行B超和MRI随访观察，发现脐膨出6例，腹裂5例，消化道畸形6例，其他3例。18例行手术治疗，其中产房外科11例。术后多途径营养支持14例。采集脐带血20例。结果20例中治愈14例，因多发严重畸形和家属放弃治疗死亡6例。11例施行产房外科，其中腹裂5例，治愈4例；巨型脐膨出4例，治愈1例，术后31d意外死亡1例，放弃治疗死亡2例，普通型脐膨出2例Ⅰ期手术治愈。消化道畸形5例治愈，1例好转。脐带血成功回输12例。结论对新生儿外科畸形早期诊断和综合治疗，有助于避免严重并发症，降低病死率。产房外科的实施，能在最短时间内中断疾病对患儿的损害。产时脐带血采集和自体回输，提高了输血安全性。

Early surgical intervention of neonatal abnormalities

Objective To evaluate the survival rate of delivery room surgery in managing neonatal congenital abnormalities. Methods Twenty fetuses with abnormal ultrasound and MRI findings were followed up. 6 omphalocele, 5 gastroschisis, 6 gastrointestinal lesions and 3 other abnormalities were detected. Eighteen of them were operated on, 11 of them in the delivery room. Nutritional support was administrated in 14 patients. The cord blood was collected at delivery. Results Fourteen patients survived while treatment was withdrawn at the requests of the family in 6 patients. Four patients with gastroschisis and two with omphalocele survived. Of four patients with giant ompholacele, one survived, one died 31 days post-operatively the two died after treatment withdrawal. Five patients with gastrointestinal anomalies were successfully operated on and one improved with conservative treatment. Twelve patients received cord blood autotransfusion. Conclusions Early delivery room surgery may reduce infant mortality.