脱细胞异体真皮治疗脐膨出的病例对照研究

Case-control study of acellular dermal matrix for treating pcromphalus

目的探讨脱细胞异体真皮（acellular dermal matrix，ADM）对脐膨出的治疗作用，并与传统手术比较其优越性，为脐膨出的治疗提供合理有效的一期手术治疗方式。方法将2012年1月1日至2015年6月51日收住院，采用ADM生物补片手术治疗的17例患儿列入ADM组；将2006年8月1日至2011年12月31日收住院，采用传统手术治疗的19例患儿列人传统组。对比术后并发症和死亡、体温、心率、呼吸频率、麻醉复苏时间、呼吸机使用时间、住院天数、腹腔内压力等观察指标。结果术后ADM组并发症除了败血症、肠梗阻、下肢水肿等并发症以外，其他并发症及死亡例数均低于传统组，差异均有统计学意义（P〈0．05）。术后ADM组体温、心率、呼吸频率、麻醉复苏时间、呼吸机使用时间、住院天数、腹腔内压力均低于传统组，差异有统计学意义（P〈0．05）。结论脱细胞异体真皮治疗脐膨出，突破了传统手术方式，可明显降低术后并发症发生率和死亡率的发生，降低住院天数，为脐膨出的治疗提供合理有效的手术治疗方式，并为临床一期治疗的可行性研究提供科学依据。

Objective To explore the therapeutic efficacies of acellular allogenic dermal matrix （ADM） for pcromphalus and compare its superiority to traditional operation so as to provide a reasonable and effective one-stage operation for pcromphalus. Methods A total of 16 patients from January 1, 2012 to June 31, 2015 were designated as experimental group. And another 16 patients undergoing traditional ADM biological patching from August 1, 2006 to December 31, 2011 were set as control group. Two groups were compared with regards to postoperative complications, mortality, body temperature, heart rate, respiratory rate, anesthetic recovery time, duration of mechanical ventilation, hospital stay and intra-abdominal pressure, et al. Results In addition to sepsis, intestinal obstruction, lower extremity edema, postoperative complications and mortality in experimental group were lower than those in control group （P〈0. 05）. The differences had statistical significance. The parameters of body temperature, heart rate, respiratory rate, anesthetic recovery time, mechanical ventilation time, hospital stay and intra-abdominal pressure in experimental group were lower than those in control group （P〈0. 05）. And the differences had statistical significance. Conclusions For pcromphalus, ADM may break through the traditional operative mode, reduce postoperative morbidity and mortality significantly, shorten hospital stay and provide scientific rationales for one-stage operatio.