Martin Abigail E, Khan Adeel, Kim Daniel S, Muratore Christopher S, Luks Francois I
Department of Surgery, Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.
J Pediatr Surg. 2009 Jan;44(1):178-82. doi: 10.1016/j.jpedsurg.2008.10.031.
Giant omphaloceles present a unique challenge to pediatric surgeons because of the difficulty in obtaining timely, tension-free closure of tissues over the defect. Reports of the use of tissue expanders in the subcutaneous space, intramuscular space, or intraabdominal cavity have illustrated the usefulness of this technique to provide biologic closure of abdominal wall defects. However, these reports have focused on use of tissue expanders as a second-line treatment after other options, such as silastic silos or attempted primary closure, have failed.
We report 2 cases in which intraabdominal tissue expanders were used as a primary strategy to obtain closure of giant omphalocele defects.
The first patient was a baby boy born at 36 weeks by date who was prenatally diagnosed with a giant omphalocele. An intraabdominal tissue expander was placed at 2 weeks of age. The tissue expander was removed and his abdomen was primarily closed at 8 weeks of age. The second patient was born at 25 weeks gestation as part of a twin gestation with severe intrauterine growth retardation (600 g birth weight). Bedside reduction was not attempted because of severe pulmonary hypertension and significant loss of abdominal domain because of herniated liver and bowel. At 8 months of age, she underwent laparoscopically assisted placement of an intraabdominal tissue expander. At 9 months of age, the tissue expander was removed, all abdominal viscera were reduced, and the defect was closed using only an 8 x 8-cm piece of AlloDerm (LifeCell, Branchburg, NJ). Both children are currently at home and doing well.
We believe that early use of intraabdominal tissue expanders provides a more expedient method of obtaining closure of the defect in giant omphaloceles.
巨大脐膨出对小儿外科医生来说是一项独特的挑战，因为要及时、无张力地闭合缺损上方的组织很困难。关于在皮下间隙、肌间隙或腹腔内使用组织扩张器的报道表明了该技术在腹壁缺损生物闭合方面的有效性。然而，这些报道主要关注在其他方法（如硅橡胶袋或尝试一期闭合）失败后，将组织扩张器作为二线治疗方法的应用。
我们报告2例将腹腔内组织扩张器作为闭合巨大脐膨出缺损的主要策略的病例。
首例患者为一名预产期36周出生的男婴，产前诊断为巨大脐膨出。在其2周龄时放置腹腔内组织扩张器。8周龄时取出组织扩张器并一期闭合腹部。第二例患者为25周妊娠出生的双胞胎之一，出生体重600克，有严重的宫内生长迟缓。由于严重的肺动脉高压以及肝脏和肠管疝出导致腹腔范围明显缩小，未尝试床边还纳。8月龄时，她接受了腹腔镜辅助下腹腔内组织扩张器置入术。9月龄时，取出组织扩张器，将所有腹腔脏器还纳，仅使用一块8×8厘米的脱细胞真皮基质（LifeCell公司，新泽西州布兰奇堡）闭合缺损。两名患儿目前均在家中，情况良好。
我们认为早期使用腹腔内组织扩张器为闭合巨大脐膨出缺损提供了一种更便捷的方法。
