新生儿腹裂的外科治疗

Surgery treatment of gastroschisis

目的总结分析腹裂非全麻插管麻醉下I期缝合的疗效。方法回顾性分析1999年7月至2007年3月收住的18例新生儿腹裂患儿,分为传统全麻插管下手术组与非全麻插管手术组,两组患儿出生体重、出生至手术时间、术后进食时间、住院天数、住院费用作对比。结果全麻插管下手术组16例,死亡1例,其余痊愈出院。非全麻插管下手术组:1例住院19天痊愈出院,另一例于第10天自动出院,在当地医院继续住院3天后痊愈。全麻插管下手术组与非全麻插管下手术组出生体重(2·65±0·81kg比2·44±0·09kg)、出生至手术时间(5·75±2·76h比2·75±3·18h)对比,两组无明显差异,全麻插管下手术组术后进食时间、住院天数明显长于非全麻插管手术组(13·8±1·48d比9±2·83d)(28·44±5·96d比14·5±6·36d),全麻插管下手术组住院费用明显高于非全麻插管手术组(19005±3503元比9626±572元)。结论非全麻插管下一期肠管回纳治疗先天性腹裂可避免机械通气、明显提早进食时间、减少住院天数及费用,是一种安全可靠兼具美容的方法,产前诊断,产房手术为非全麻插管麻醉下一期肠管回纳治疗先天性腹裂提供了更大的可能性。

Objective： To investigate the results of gut reduction of gastroschisis in newborn without general anesthesia （GA） . Methods： The datas were collected on 18 newborn with Gastroschisis from July, 1997 to March, 2007. Data included birth weight, the time of reduction, the time of feed , the time of hospital stay, and hospital fees. Results ： 16 cases were treated with reduction under intubation and GA while the other 2 cases were attemted with reduction under no intubation and GA. 15 cases were cure in the 16 cases under intubation and GA. 1 case was cure in the 2 cases under no intubation and GA. the other one want to diacharge after admission of 10 days, and be cure after continous treatmemt of 3 days in localitial hospital. Birth weight and the time of reduction was same in two groups ; The time of feed and hospital stay in gloup with reduction under intubation and GA were longer than the other group ; Hospital charge much high. Conclusion ： Gut reduction of gastroschisis in newborn without intubation and general anesthesia （GA） do better in terms of avoiding ventilation, feeds earlier, going home earlier and less hospital fees, and is a safe and cosmetic method. Prenatal diagnosis and operation in deliveryroom provide more possible to gut reduction of gastroschisis in newborn without general anesthesia （GA） .