Murphy Fiona J, Mohee A, Khalil Basem, Lall Anupam, Morabito Antonino, Bianchi Adrian
Royal Manchester Children's Hospital, Manchester, UK.
Pediatr Surg Int. 2009 Feb;25(2):145-7. doi: 10.1007/s00383-008-2303-9. Epub 2008 Dec 13.
Following the advent of laparoscopic surgery, cosmesis has become an important factor in surgical decision making. The circumumbilical incision combines the advantages of an open approach with an aesthetically pleasing scar on the abdomen. The aim of this paper is to examine the results of this incision in neonatal laparotomy.
All neonates who underwent a supraumbilical circumferential skin incision for an exploratory laparotomy in the period 1997-2007 were reviewed. Gestational age, operative procedure, conversions to standard laparotomy, complications and follow-up were recorded.
A total of 55 neonates with a gestational age ranging from 28 to 42 weeks had 57 operative procedures. The indications were: nonrotation of midgut in 18; intestinal atresia in 18; necrotizing enterocolitis/spontaneous perforation in 10; meconium ileus in 5; intestinal duplication in 2; patent vitellointestinal duct (VID) in 2. No conversion to a standard transverse incision was necessary in any case. However, an omega extension was made in four patients. The complications encountered include wound infection in one; caecal perforation in one and incisional hernia in two cases. Subsequent follow-up revealed that all incisions had healed and the scars were almost imperceptible as affirmed by parental satisfaction during outpatient clinic consultation.
The circumumbilical approach is a safe, flexible and easily reproducible approach providing adequate exposure for most abdominal surgeries in the neonate. The low complication rate and pleasing aesthetic outcome are much appreciated by parents and operators alike.
随着腹腔镜手术的出现，美容效果已成为手术决策中的一个重要因素。脐周切口结合了开放手术的优点以及腹部美观的瘢痕。本文旨在探讨这种切口在新生儿剖腹手术中的效果。
回顾了1997年至2007年期间所有因探索性剖腹手术而接受脐上环形皮肤切口的新生儿。记录了胎龄、手术操作、转为标准剖腹手术的情况、并发症及随访情况。
共有55例胎龄在28至42周的新生儿接受了57次手术。手术指征为：中肠旋转不良18例；肠闭锁18例；坏死性小肠结肠炎/自发性穿孔10例；胎粪性肠梗阻5例；肠重复畸形2例；卵黄管未闭（VID）2例。所有病例均无需转为标准横向切口。然而，有4例患者做了Ω形延长。遇到的并发症包括1例伤口感染；1例盲肠穿孔和2例切口疝。随后的随访显示，所有切口均已愈合，瘢痕几乎难以察觉，门诊咨询时家长的满意度也证实了这一点。
脐周入路是一种安全、灵活且易于重复的入路，可为大多数新生儿腹部手术提供足够的暴露。其低并发症发生率和良好的美容效果受到家长和手术医生的高度赞赏。
