脐带悬吊延期修补治疗巨型脐膨出

Experience of delayed primary closure of giant omphalocele after umbilical cord suspension procedure

目的探讨脐带悬吊延期修补腹壁缺损治疗巨型脐膨出的临床效果。方法设计脐带悬吊囊膜、逐渐收紧囊膜还纳膨出内脏器官的方法治疗10例巨型脐膨出，对其治疗过程和临床效果作回顾性总结。结果10例开始悬吊的平均日龄1d（1～2d），悬吊平均时间21．7d（15-37d）。10例均一次手术修补缺损，2例同时行Ladd术。术后2例出现腹壁切口疝，1例出现呼吸困难，行呼吸机辅助通气3d后好转。术后开始进食时间3d（2-6d），正常喂养进食平均时间7d（5-10d）。结论脐带悬吊延期修补治疗巨型脐膨出具有治疗简单、经济、一次手术完成，同时具有Silo袋法及保守疗法的优点，临床效果较好。

Objective To investigate the clinical efficacy of delayed primary closure of giant omphalocele after umbilical cord suspension procedure. Methods The surgery procedure and therapeutic efficacy from 10 cases of giant omphaloceles newborns undertaking with umbilical cord suspension, were analyzed retrospectively. Results The average age of 10 cases of newborn was 1 day. The duration of suspensions procedure ranged from 15 to 37 days （average 21.7 days）. All cases underwent delayed surgical repair after suspension and lesion was repaired successfully. Among them two patients underwent Ladd＇s procedures meanwhile. In term of postoperative complications, two cases were complicated with abdominal incision hernias; one case had symptom of dyspnoea and three days of assistance using mechanical ventilator improved breathing. All cases started to breastfeeding in postoperative 2-6 days （3 days average）, while the feeding time in conventional delayed primary closure of giant omphalocele procedure was averagely 7d （ranging from 5-10 d）. Conclusions some advantages can be seen in this procedure, including easy performance, economic, and better clinical outcome.