产前诊断为脐疝患儿的一次性外科手术治疗

作     者：Rijhwani A. Davenport M. Dawrant M. 宁亮 

作者机构：Department of Paediatric Surgery Kings College Hospital SE5 9RS London United Kingdom 

出 版 物：《世界核心医学期刊文摘（儿科学分册）》 (Dkgest of the World Latest Medical Information)

年 卷 期：2005年第1卷第8期

页      面：41-42页

学科分类：1002[医学-临床医学] 100202[医学-儿科学] 10[医学] 

主　　题：产前诊断 外科手术 外科并发症 非手术方法 闭合术 保守性 脓毒症 肠内营养 呼吸衰竭 机械通气 

摘      要：Background/Purpose: The management of exomphalos is controversial with many centers in the United Kingdom and elsewhere advocating a conservative nonsurgical approach for the larger examples. Nevertheless, this approach is not without pr oblems or complication. The aim of the study was to ascertain the outcome of all infants with an antenatally diagnosed exomphalos treated recently at our instit ution using a policy of aggressive abdominal wall closure. Methods: This is a re trospective review of all infants with exomphalos treated from January 1995 to S eptember 2002. Results: There were 35 infants, all of whom underwent surgery. Th ese were separated into 3 groups: group A (all exomphalos minor) underwent primary closure (n = 11), group B (exomphalos maj or) underwent primary closure (n = 13), and group C (exomphalos major)- underwe nt staged closure involving a silo (n = 11). Infants in group C had a lower birt h weight (P = .05) and were less mature (P = .06). They required longer periods of ventilation (P.001), a longer hospital stay (P =. 001), and a longer period to achieve full enteral feeds (P .001). Overall survival was 34 (97% ) of 35 infants. One premature infant who was born with a ruptured exomphalos sac (birth weight, 862 g) died of nonsurgical complications (sepsis and respiratory failur e) early after the creation of a silo. Conclusions: An aggressive surgical appro ach in infants with exomphalos is a safe option resulting in effective abdominal wall closure. This requires a skilled multidisciplinary approach and possibly g reater resources than other options.