程序化包扎法、延期手术治疗巨型脐膨出的疗效分析

Efficacy of treating giant omphalocele by procedural dressing and delayed closure.

目的探讨新生儿期采用程序化包扎法、延期手术治疗巨型脐膨出的安全性和有效性。方法回顾性分析2016年12月至2018年7月广州市妇女儿童医疗中心收治的采用程序化包扎法,延期手术治疗的巨型脐膨出患儿临床资料。结果7例患儿出生时囊膜均无破裂,包扎期待治疗期间无囊膜感染、破裂、肠梗阻、中断包扎等并发症发生,未再次入院;囊膜达到干痂期中位数时间为5(4~5)d,囊膜完成上皮化中位数时间为65(57~68)d,家长培训时间中位数6(3~12)d,住院时间中位数21(19~29)d;7例患儿均存活,其中6例行腹壁缺损修补手术,2例术后分别需要5 h和17 h呼吸机支持,住院时间中位数9.5(7.25~10.25)d,术后均未出现伤口预后不良、切口疝等手术并发症。1例正在等待延期修补术。结论程序化包扎法、延期手术治疗巨型脐膨出的方法是安全有效的,其对巨型脐膨出远期预后的影响需进一步随访研究。

Objective To explore the safety and efficacy of procedural dressing and delayed operation for neonatal giant omphaloceles.Methods A retrospective study was performed for clinical data of giant omphaloceles treated by procedural dressing and delayed closure from December 2016 to July 2018.Results A total of 7 cases were recruited.There was no rupture of capsule membrane during birth.There were no such complications as capsule infection,rupture,intestinal obstruction,bandaging difficulty and re-admission during treatment.The capsule membrane for dry scar period needed 5(IQR:4~5)d days.The capsule membrane for completing epithelialization needed 65(57-68)days.It took 6(3-12)days for parents to learn dressing.The median length of hospital stay was 21(19-29)days.All seven cases survived.6 cases underwent abdominal wall defect repairing.And 2/7 cases required ventilator supports for 5 and 17 hours respectively.The median length of hospital stay was 9.5(7.25-10.25)days.Neither poor wound healing nor incisional hernia occurred postoperatively.One case still awaited delayed closure.Conclusion Procedural dressing and delayed closure are safe and effective for treating giant omphaloceles.However,long-term prognosis needs more follow-up studies.