婴幼儿脐膨出脐部重建脐位置的选择

Position selecting for umbilical reconstruction in infants with omphalocele

目的探讨婴幼儿脐膨出腹壁重建时脐部定位的选择。方法收集2019年1月至12月浙江大学医学院附属儿童医院收治的脐膨出患儿共55例,其中男35例,女例20;出生体重范围为1800~3920 g。患儿均为脐部型脐膨出,其中小型脐膨出16例,巨大脐膨出34例,巨大脐膨出术后腹壁疝5例。收集统计150例正常腹壁小儿的脐部位置临床资料,按年龄将正常腹壁小儿分为早产儿组、足月儿新生儿组、3个月月龄组、6个月月龄组、1岁龄组以及2岁龄组共6组,每组均为男12例,女13例。通过测量正常小儿不同年龄组剑突至脐部的距离(xiphoid-center of umbilicus,XU)、剑突至耻骨联合上缘的距离(xiphoid-pubic symphsis,XP),统计正常小儿XU/XP的特点,作为指导脐部定位的依据,55例患儿根据腹壁缺损大小、腹壁肌肉发育情况以及膨出物大小,选择不同的手术方式。结果不同年龄组正常腹壁小儿的XU/XP值为0.53~0.56,平均值为0.54。55例脐膨出患儿均顺利完成手术,其中10例小型脐膨出腹壁缺损较小(约1~2 cm)的在腹壁缺损处行脐部重建;6例小型脐膨出腹壁缺损稍大(约3~5 cm)的在缺损下缘行脐部重建;29例巨大型脐膨出在XU/XP为0.54处行脐部重建例;5例巨大脐膨出因腹壁肌层发育较差,仅缝合腹壁皮肤和筋膜层,未予以脐部重建;5例巨大脐膨出术后腹壁疝小儿在XU/XP为0.54处行脐部重建,术后见脐位置良好。结论XU/XP为0.53~0.56是一个理想的脐重建位置的选择,脐膨出腹壁重建时可以此为参考。

Objective To explore the options of umbilical localization in abdominal wall reconstruction for umbilical omphalocele in infants.Methods From January to December 2019,clinical data were reviewed for 55 infants with omphalocele.There were 35 boys and 20 girls with a birth weight range of 1,800 to 3,920 g.There were small omphalocele(n=16),giant omphalocele(n=34)and abdominal hernia after giant omphalocele(n=5).Clinical data were collected from 150 children with normal abdominal wall.Based upon age,they were divided into 6 groups of premature infants,full-term infants,3-month-old,6-month-old,1-year-old and 2-year-old.Each group consisted of 12 boys and 13 girls.By measuring the distance from xiphoid-center of umbilicus(XU)and xiphoid-pubic symphsis(XP)in different age groups,the characteristics of XU/XP in normal children were counted as the basis for guiding umbilical localization and 55 children selected for different surgical approaches according to the size of abdominal wall defects,abdominal wall muscle development and bulge size.Results XU/XP values of normal abdominal wall children in different age groups had a mean value of 0.54(0.53-0.56).All operations were successful.Umbilical reconstruction was performed for small omphalocele abdominal wall defect(1-2 cm)(n=10)and slightly larger(3-5 cm)in lower edge defect(n=6);giant omphalocele in XU/XP 0.54(n=29);giant omphalocele due to poor development of abdominal wall muscular layer(n=5).Only abdominal wall skin and fascia layer were sutured without umbilical reconstruction;giant omphalocele after abdominal hernia in XU/XP 0.54(n=5)and postoperative umbilical position was decent.Conclusions The position of XU/XP at 0.53~0.56 is an ideal choice for umbilical reconstructing different sizes of omphalocele.