Division of Pediatric Surgery, David Geffen School of Medicine at UCLA, Box 709818, Los Angeles, CA 90095-7098, USA.
J Pediatr Surg. 2011 Nov;46(11):2115-8. doi: 10.1016/j.jpedsurg.2011.07.010.
Liver herniation is a rare occurrence in gastroschisis. We sought to determine the incidence and prognosis of liver herniation in patients with gastroschisis.
From December 1995 to March 2010, 117 patients with gastroschisis received care by our division. Operative reports were reviewed to identify patients with liver herniation. Logistic regression was used to determine the impact of liver herniation on survival, taking into account gestational age and birth weight.
The incidence of liver herniation was 6%. Survival rates were 43% with liver herniation and 97% without liver herniation. Liver herniation was associated with a significantly higher rate of mortality, taking into account estimated gestational age and birth weight (P < .001). Patients who had liver herniation documented by prenatal ultrasound had significant liver herniation at birth and died postnatally. Patients with liver herniation who died required large silos and were noted to have comorbidities including lower birth weight, pulmonary hypoplasia, and sepsis. Biologic patches were necessary for closure in patients with greater extent of liver herniation.
Liver herniation was found in 6% of patients with gastroschisis and was associated with a high rate of mortality. Liver herniation appears to be a risk factor for poor outcome in gastroschisis. Documentation of liver herniation may be helpful in prenatal consultation for gastroschisis.
肝脏疝出在腹裂中是一种罕见的现象。我们旨在确定患有腹裂的患者中肝脏疝出的发生率和预后。
1995 年 12 月至 2010 年 3 月，我们科室收治了 117 例腹裂患者。回顾手术报告以确定是否存在肝脏疝出。采用逻辑回归分析，考虑胎龄和出生体重，确定肝脏疝出对生存率的影响。
肝脏疝出的发生率为 6%。有肝脏疝出的患者存活率为 43%，无肝脏疝出的患者存活率为 97%。考虑到胎龄和出生体重，肝脏疝出与死亡率显著相关（P<.001）。经产前超声检查发现有肝脏疝出的患者，在出生时肝脏疝出明显，并在出生后死亡。肝脏疝出且死亡的患者需要大的造口袋，并且存在包括低出生体重、肺发育不全和败血症等并发症。肝脏疝出程度较大的患者需要使用生物补片进行修复。
在患有腹裂的患者中，发现有 6%的患者存在肝脏疝出，且与高死亡率相关。肝脏疝出似乎是腹裂不良预后的一个危险因素。在腹裂的产前咨询中，记录肝脏疝出可能会有所帮助。
