同种异体脱细胞真皮修补术治疗巨型脐膨出的疗效分析

Efficacy of allogeneic acellular dermal mantrix in repairing giant omphalocele.

目的总结采用同种异体脱细胞真皮修补术治疗巨型脐膨出的临床经验。方法回顾性分析2014年3月至2019年11月应用同种异体脱细胞真皮修补术治疗的31例巨型脐膨出患儿病例资料,其中男童18例,女童13例,体重1.8~3.5 kg,腹壁缺损均>5 cm,就诊时间1 h至1 d,手术均在就诊后3~12 h内完成,31例羊膜囊内均有小肠、结肠、肝脏。合并先天性心脏病12例(法洛四联症、室间隔缺损、房间隔缺损、动脉导管未闭),合并21-三体畸形1例,合并多指1例,合并肠闭锁1例,合并梅克尔憩室2例,合并肠旋转发育不良3例。术中切除羊膜囊,合并心脏畸形者先观察暂不予处理;合并多指者待患儿3个月再行手术切除;合并肠闭锁者直接行肠切除、肠吻合术;合并梅克尔憩室但肠道通畅者未作处理;合并肠旋转发育不良者行Ladd矫治术。分离脐部缺损周边肌肉组织,将生物补片与肌肉缝合修补缺损,行脐部成形术。术后呼吸机辅助通气2~5 d,7 d后慢慢开奶。出院后随访1年。结果31例患儿均治愈出院,1例发生补片排斥反应,反复发热、渗液,伤口裂开,对症治疗后慢慢好转。2例脐部伤口愈合欠佳,形成巨大瘢痕填充。1例出现腹壁疝,腹腔容积扩张不满意,脐部肿物突出明显,择期再次行手术治疗。2例术后肠梗阻,保守治疗后好转。结论对于巨型脐膨出,同种异体脱细胞真皮修补兼容性好,不良反应少,术后恢复可,并发症少,是一种理想的治疗巨型脐膨出的方法。

Objective To summarize the therapeutic experiences of giant omphalocele with human acellular dermal mantrix.Methods Thirty-one cases of giant omphalocele were treated with human acellular dermal mantrix from March 2014 to November 2019.There were 18 boys and 13 girls with a body weight of(1.8-3.5)kg and with an abdominal wall defect of>5 cm.The presenting time was 1 h-1 d after birth.Operation was completed within(3-12)hours.All 31 cases had small intestine,colon and liver in amniotic sac.There were congenital heart disease(tetralogy of Fallot,ventricular septal defect,atrial septal defect&patent ductus arteriosus)(n=12),21-trisomy(n=1),polydactyly(n=1),intestinal atresia(n=1),Meckle s diverticulum(n=2)and intestinal malrotation(n=3).Amniotic sac was excised intraoperatively.Cases of heart malformation were observed and left untreated.Polydactyly was re-operated for removing extra fingers after several months.Meckel s diverticulum and intestinal patency were observed conservatively.For intestinal atresia,intestinal resection and anastomosis were performed.Ladd s correction was performed for intestinal malrotation.During omphalocele repair,peripheral muscle tissue of umbilical cord defect was separated and then biological patch sutured with muscle for repairing defect.Umbilical cord was formed ultimately.After operation,ventilator-assisted ventilation was performed for 2-5 days and milk was provided gradually after 1 week.The follow-up period was one year after discharge.Results All 31 cases were cured and discharged from hospital.In 1 case of patch rejection,there were recurrent fever,wound exudate and wound dehiscence.However,there were improvements after symptomatic treatment.Two cases of umbilical cord wound healed poorly and formed a large scar filling.In 1 case of abdominal hernia,abdominal volume expansion was not satisfactory and umbilical mass became prominent.So re-operation was performed.Two cases of postoperative intestinal obstruction improved after conservative measures.Conclusion For giant omphalocele,biological patch repair is an ideal treatment with excellent compatibility,fewer adverse reactions or complications and faster postoperative recovery.