自体脐带修补先天性腹裂的远期疗效评价

Long-term effect and evaluation of autoiogous umbilical cord repair gastroschisis

目的探讨自体脐带修补先天性腹裂的可行性及对患儿生长发育的影响。方法回顾性分析郑州市儿童医院1992年1月至2011年1月采用自体脐带修补30例先天性腹裂的临床资料，其中男22例，女8例。平均年龄（10±3）h。平均体质量（2．8±0．5）kg。30例均为脐右侧裂开，裂口长度2．5～5cm。平均长度3．5cm。气管插管静脉复合麻醉。首先应将脱出的肠管减压、排空，如发现病变肠管同时进行治疗。术者用双手食指扩张腹腔10-20min，使其容积增大。还纳肠管。于脐右侧纵行剪开脐带，结扎并切除脐动、静脉，将脐片向右侧翻转覆盖于裂口上，做适当修剪后与周围腹壁作全层间断缝合。术后伤口碘伏纱布覆盖，隔日换药。自体脐带修补平均手术时间为65min。结果本组自体脐带修补患儿存活26例，出现严重合并症死亡2例，自动出院2例，存活率为86．7％。术后随访2～20年，与正常同龄儿在智力、身高、体质量方面相比差异不明显。结论自体脐带腹裂修补术具有取材方便、操作简单、术后容易管理，远期疗效确切，为进一步广泛临床应用提供有力证据。

Objective To explore the feasibility oI autologous umbilical cord repair gastroscnlsls and influence on the growth of children. Methods Retrospective analyses were conducted for 30 cases of gastroschisis with autologous umbilical cord repair from January 1992 to January 2011. Results There were 22 males and 4 females with an average age of （10 ± 3） h and an average body weight of （2. 8 ± 0. 5） kg. Among them, 26 cases with autologous umbilical cord repair survived, 2 died of serious complications and another 2 had an automatic discharge. The survival rate was 86. 7%. After a follow-up period of 2-20 years, there were no significant differences with normal same-age children in intelligence, height and body weight. Conclusions The procedure of autologous umbilical cord repair gastroschisis is both convenient and simple to operate with easy postoperative management and better long-term outcomes. Wider clinical application is advocated.