Debeugny P, Canarelli J P, Bonnevalle M, Besson R, Ricard J, Herlin P, Ducloux B
Service de Chirurgie Pédiatrique, CHU Lille.
Chir Pediatr. 1990;31(1):18-25.
In 14 newborns with gastroschisis, fascial closure was effected by muscular suture associated with teflon mesh prosthesis interposition. This was realized either in urgency during neonatal period (9), either secondly (5). Neonatal cases were treated between 0 h 30 and 5 h of age. Pulmonary hyper-pressure risk was very important when primary suture was early employed (card freq: 150 b. min-1. PA syst: 60 cm Hg; pulm pres: 20 cm Hg). When we used a teflon mesh prosthesis, we had 8 good results and only one initial death. 5 complications were represented by cutaneous ischemia which spontaneously disappeared (1), ischemia with infection and partial necrosis (2), important necrosis with teflon mesh prosthesis exteriorization (2). It has been definitely possible to achieve complete fascial in 7 newborns. Only one of them had a little ventral hernia. 5 newborns were early treated by simple skin coverage (Gross) as primary management. They have had teflon mesh prosthesis between 5 and 14 M of age and have undergone excision of the teflon mesh prosthesis and fascial repair without difficulty (5 good results). With teflon mesh prosthesis for treating congenital abdominal defects, abdominal hyper-pressure and pulmonary complications are exceptional. Local complications are very limited because of good vascular conditions. We did not have any adherences because of teflon mesh prosthesis good biological and histological tolerance. Digestive complications (statis, septicemia...) have been few and mild because physiological intra abdominal pressure has been early obtained.
在14例腹裂新生儿中，通过肌肉缝合并置入聚四氟乙烯网片假体实现筋膜闭合。这一操作在新生儿期急诊进行（9例），或择期进行（5例）。新生儿病例在出生后0小时30分至5小时接受治疗。早期采用一期缝合时，肺动脉高压风险非常高（心率：150次/分钟；肺动脉收缩压：60厘米汞柱；肺压：20厘米汞柱）。当我们使用聚四氟乙烯网片假体时，取得了8例良好效果，仅1例初期死亡。5例并发症表现为皮肤缺血（1例，自发消失）、缺血伴感染和部分坏死（2例）、聚四氟乙烯网片假体外露伴严重坏死（2例）。7例新生儿成功实现了完全筋膜闭合。其中仅1例有轻度腹疝。5例新生儿早期采用简单皮肤覆盖（格罗斯法）作为主要治疗方法。他们在5至14个月大时置入聚四氟乙烯网片假体，并顺利接受了聚四氟乙烯网片假体切除和筋膜修复（5例良好效果）。使用聚四氟乙烯网片假体治疗先天性腹部缺损时，腹部高压和肺部并发症罕见。由于血管条件良好，局部并发症非常有限。由于聚四氟乙烯网片假体具有良好的生物学和组织学耐受性，我们未出现任何粘连。消化并发症（淤滞、败血症等）很少且轻微，因为早期获得了生理腹内压。
