Werbeck R, Koltai J
Department of Pediatric Surgery, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany.
Eur J Pediatr Surg. 2011 Oct;21(5):292-5. doi: 10.1055/s-0031-1277222. Epub 2011 Jun 15.
Although the early definitive closure of gastroschisis is possible in many cases, there is an ongoing discussion about the advantages of staged reduction. Different strategies and materials have been described to wrap the bowel for protection and reduce heat and fluid loss. The variety of devices ranges from prosthetic patches to biomaterials. We present use of the umbilical cord for temporary coverage in primarily irreducible gastroschisis.
After revision and reduction of as much gut as possible under constant monitoring of the bladder pressure, the remaining eviscerated intestine is covered by the longitudinally split umbilical cord. Over the following days the continued reduction of the bowel relies on gravity, assisted by progressive compression by the shrinking umbilical cord tissue. At 10 days after performing the umbilical cord flap, it is possible to close the fascia without complications using gentle pressure.
Since 1991 we have used this umbilical cord flap for staged reduction in 17 infants (10 females, 7 males) with giant gastroschisis. There were no complications related to use of the umbilical cord flap, no infections or NEC episodes, and no mortality. Length of hospital stay was 5 weeks on average. In 3 patients the course was complicated by associated defects or an underlying malformation.
Our experience confirms the advantage of a staged reduction in giant gastroschisis. The use of autogenic material such as the umbilical cord has advantages such as low infection rates and easy availability.
尽管在许多情况下早期确定性关闭腹裂是可行的，但关于分期还纳的优势仍在持续讨论。已经描述了不同的策略和材料来包裹肠管以进行保护并减少热量和液体流失。各种装置从人工补片到生物材料不等。我们介绍了在原发性不可还纳的腹裂中使用脐带进行临时覆盖。
在持续监测膀胱压力的情况下尽可能多地还纳肠管后，将纵向劈开的脐带覆盖剩余的脱出肠管。在接下来的几天里，肠管的持续还纳依靠重力，并由逐渐收缩的脐带组织进行渐进性压迫辅助。在进行脐带皮瓣术后10天，可以在轻柔压力下无并发症地关闭筋膜。
自1991年以来，我们已将这种脐带皮瓣用于17例巨大腹裂婴儿（10例女性，7例男性）的分期还纳。未发生与使用脐带皮瓣相关的并发症，无感染或坏死性小肠结肠炎发作，也无死亡病例。平均住院时间为5周。3例患者的病程因合并缺陷或潜在畸形而复杂化。
我们的经验证实了巨大腹裂分期还纳的优势。使用自体材料如脐带具有感染率低和易于获取等优点。
