Kapfer Stephanie A, Keshen Tamir H
Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO 63110,USA.
J Pediatr Surg. 2006 Jan;41(1):216-20. doi: 10.1016/j.jpedsurg.2005.10.093.
The management of giant omphalocele presents a major challenge to pediatric surgeons. Current treatment modalities often result in wound infection, fascial separation, and abdominal domain loss. Human acellular dermis (AlloDerm), as a primary abdominal fascial substitute, may prevent these complications. We present our experience with its application in neonates with giant omphalocele.
Charts of patients with giant omphalocele from January 2003 to September 2004 were reviewed and data collected regarding wound healing, rate of infection, ventilatory support, and outcome.
Three neonates underwent abdominal wall closure with AlloDerm (gestational ages: 38, 37, and 28 weeks; birthweights 2880, 2640, and 1160 g, respectively). All had cardiac anomalies; 1 required cardiac surgery and 1 was ventilator-dependent, secondary to pulmonary hypoplasia. Omphalocele repair was performed on day-of-life 9, 2, and 87. No fascial dehiscence or infection was encountered. Neovascularization was noted by day 7. Two died of cardiopulmonary disease (6 months and 1 year). The third exhibited normal growth and development without complication.
AlloDerm provides visceral coverage without compromising cardiopulmonary function, diminishing abdominal domain, or requiring multiple operations, allowing prompt treatment of associated anomalies. AlloDerm represents an exciting alternative in the treatment of giant omphalocele. Further study is required to determine long-term benefits.
巨大脐膨出的治疗对小儿外科医生来说是一项重大挑战。目前的治疗方式常常导致伤口感染、筋膜分离和腹腔容量丧失。人脱细胞真皮（AlloDerm）作为一种主要的腹部筋膜替代物，可能预防这些并发症。我们介绍其在巨大脐膨出新生儿中的应用经验。
回顾2003年1月至2004年9月巨大脐膨出患者的病历，收集有关伤口愈合、感染率、通气支持和预后的数据。
3例新生儿使用AlloDerm进行腹壁关闭（胎龄分别为38周、37周和28周；出生体重分别为2880g、2640g和1160g）。所有患儿均有心脏畸形；1例需要心脏手术，1例因肺发育不全依赖呼吸机。分别在出生后第9天、第2天和第87天进行脐膨出修复。未出现筋膜裂开或感染。第7天可见新生血管形成。2例死于心肺疾病（分别为6个月和1岁）。第3例生长发育正常，无并发症。
AlloDerm可提供内脏覆盖，而不影响心肺功能、减少腹腔容量或需要多次手术，从而能及时治疗相关畸形。AlloDerm是巨大脐膨出治疗中一种令人兴奋的替代方法。需要进一步研究以确定其长期益处。
