Pacilli Maurizio, Spitz Lewis, Kiely Edward M, Curry Joe, Pierro Agostino
Department of Surgery, Institute of Child Health and Great Ormond Street Hospital for Children, WC1N 1EH London, UK.
J Pediatr Surg. 2005 May;40(5):785-8. doi: 10.1016/j.jpedsurg.2005.01.042.
BACKGROUND/PURPOSE: The aim of this study was to analyze the outcome of giant omphalocele repaired in the neonatal period.
Twelve consecutive (1997-2004) neonates with giant omphalocele (defect >6 cm with liver herniation) were reviewed. A silo of Prolene mesh (Ethicon) was attached to the fascia and the defect was closed without opening the amniotic sac after sequential reduction. In 2 neonates with ruptured omphalocele a plastic sheet was inserted below the mesh. Data are reported as median and range.
Gestational age was 38 weeks (range, 32-40 weeks) and birth weight was 2.9 kg (range, 1.0-3.1 kg). The final closure was achieved at 26 days (range, 16-62 days). Three neonates (25%) died before final closure (causes: ruptured omphalocele, lung hypoplasia, cardiac anomalies, and intestinal failure). In the 9 surviving neonates, mechanical ventilation was required for 8 days (range, 2-20 days), hospital stay was 42 days (range, 23-73 days), and full enteral feeding was achieved on day 12 (range, 4-53 days). Complications included wound infection in 5 neonates and midgut volvulus in 1. Prophylactic Ladd's procedure was performed laparoscopically at a later stage in 4 children. At laparoscopy, intraperitoneal adhesions were minimal and the central liver did not preclude the operation. The 9 survivors are all well after 46 months (range, 12-67 months).
Giant omphalocele can be safely repaired in the neonatal period without opening the amniotic sac. Intestinal malrotation should be excluded and Ladd's procedure can be performed laparoscopically at a later stage.
背景/目的：本研究旨在分析新生儿期巨大脐膨出修补术的结果。
回顾了1997年至2004年连续收治的12例巨大脐膨出（缺损>6 cm且有肝脏疝出）新生儿。将聚丙烯网片（Ethicon）制成的袋状装置附着于筋膜，在逐步还纳后不打开羊膜囊关闭缺损。2例脐膨出破裂的新生儿在网片下方插入了塑料片。数据以中位数和范围表示。
胎龄为38周（范围32 - 40周），出生体重为2.9 kg（范围1.0 - 3.1 kg）。最终在26天（范围16 - 62天）实现关闭。3例新生儿（25%）在最终关闭前死亡（原因：脐膨出破裂、肺发育不全、心脏畸形和肠衰竭）。9例存活新生儿中，机械通气需8天（范围2 - 20天），住院时间为42天（范围23 - 73天），第12天（范围4 - 53天）实现完全经口喂养。并发症包括5例新生儿伤口感染和1例中肠扭转。4例儿童在后期通过腹腔镜进行了预防性Ladd手术（肠旋转不良纠正术）。腹腔镜检查时，腹腔内粘连极少，中央肝脏不影响手术。9例存活者在46个月（范围12 - 67个月）后均状况良好。
巨大脐膨出可在新生儿期安全修补，无需打开羊膜囊。应排除肠旋转不良，后期可通过腹腔镜进行Ladd手术。
