Gómez-Alcalá Alejandro V, Jiménez-Muñoz Juan, Rodríguez-Rodríguez Arnulfo, Ríos-Félix Armando, Espino-Valle Israel, Rodríguez-Hernández Héctor, Macedo-García Rolando, Castrejón-Martínez Ernesto, Mohamed-del Bosque Laura, Zárate-Miguel Rosa Eugenia
Departamento de Cirugía Pediátrica, Hospital de Especialidades 1, Centro Médico Nacional Noroeste, Instituto Mexicano del Seguro Social, Ciudad Obregón, Sonora.
Gac Med Mex. 2002 Nov-Dec;138(6):511-7.
Immediate neonatal surgery (INS) has the purpose of achieving surgical treatment of a congenital malformation in a newborn within the first few minutes after delivery. Since 1993, we have invited 15 pregnant women with sonographic diagnosis of fetal abdominal wall defect to participate in INS. All were treated by means of elective (eight cases) or emergent (seven cases) cesarean section between 33 and 38 gestational weeks. The neonates were immediately operated on the procedure beginning between 17 and 35 min after delivery. Eleven neonates had gastroschisis and primary closure was accomplished in five cases with application of auxiliary plastic patch (45.5%) and in four cases with use of native tissues only (36.4%); nine neonates survived (81.8%), and were able to be fed by mouth at 14 +/- 4.5 days. Four had omphalocele, and in three primary closure and feeding by mouth before 1 week was attained; the fourth neonate died because of coexisting malformations. The present series, even if small, is useful to affirm the safety of a procedure such as INS for both mother and child; it may contribute to improve the results of treatment of fetuses with abdominal wall defects.
新生儿即刻手术(INS)的目的是在新生儿出生后的头几分钟内对先天性畸形进行手术治疗。自1993年以来,我们邀请了15名经超声诊断为胎儿腹壁缺损的孕妇参与新生儿即刻手术。所有孕妇均在妊娠33至38周之间接受了择期剖宫产(8例)或急诊剖宫产(7例)。新生儿在出生后17至35分钟内立即接受手术。11例患有腹裂,5例应用辅助整形补片完成一期缝合(45.5%),4例仅使用自体组织完成一期缝合(36.4%);9例新生儿存活(81.8%),并在14±4.5天能够经口喂养。4例患有脐膨出,3例实现了一期缝合并在1周前开始经口喂养;第4例新生儿因合并其他畸形死亡。本系列研究尽管样本量小,但有助于确认新生儿即刻手术等手术对母婴的安全性;它可能有助于改善腹壁缺损胎儿的治疗效果。