15例先天性腹裂治疗分析

Analysis on the Treatment of 15 Cases with Congenital Gastroschisis

目的:探讨先天性腹裂的产前诊断、一期手术的效果和术后腹腔压力的变化特点。方法:回顾分析浙江大学医学院附属儿童医院2014年1月至2018年12月期间收治15例先天性腹裂患儿的产前B超、诊治过程和预后的临床资料。结果:产前B超最早在孕10周发现腹壁异常,孕18~24周明确诊断。15例患儿中,1例伴发复杂畸形放弃治疗,余14例均行一期手术治疗。术后腹腔压力最高不高于15mmHg,术后3d降至正常范围。1例患儿术后2月因肺炎、呕吐窒息死亡,余13例存活患儿生长发育情况正常。结论:先天性腹裂是新生儿一种严重的先天性畸形,产前B超可早期发现,一期手术后腹腔压力很快恢复正常范围。术后监护、合理的营养支持可以取得良好的治疗效果。

Objective:To investigate the prenatal diagnosis, the effect of one-stage surgery in newborns with congenital gastroschisis and the change of the abdominal pressure. Methods:The clinical data of 15 cases in the Children's Hospital from January 2014 to December 2018, including prenatal B-ultrasound, surgical treatment and prognosis, were retrospectively analyzed. Results:Abdominal wall abnormalities were found in prenatal B- ultrasound as early as 10 gestational weeks of gestation and diagnosed at 18- 24 gestational weeks. Among the 15 newborns, one patient with complex malformation gave up treatment and the rest patients all received one-stage surgery. The maximum postoperative abdominal pressure was not higher than 15 mmHg and decreased to normal 3 days after the surgery. Among all these 14 patients, one died of pneumonia and vomiting 2 months after the surgery, and all the others had basically normal growth and development. Conclusion:Congenital gastroschisis is a severe congenital malformation of the newborn, which can be detected by prenatal B-ultrasound in early stages. Abdominal pressure could decrease to normal range after one-stage surgery. Reasonable postoperative care and nutrition support can achieve good theapeutic effects.