延迟使用磺胺嘧啶银乳膏治疗巨大脐膨出：18 年经验。

Delayed management of giant omphalocele using silver sulfadiazine cream: an 18-year experience.

机构信息

Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.

出版信息

J Pediatr Surg. 2012 Mar;47(3):494-500. doi: 10.1016/j.jpedsurg.2011.08.014.

DOI:10.1016/j.jpedsurg.2011.08.014

Abstract

BACKGROUND/PURPOSE: To assess the value of topical silver sulfadiazine (SSD) cream in the treatment of babies with a giant omphalocele.

METHODS

From 1991 to 2008 inclusive, 20 infants with giant omphalocele (defined as >10 cm diameter) were treated with SSD, leaving a large ventral hernia to be repaired at a later date.

RESULTS

There were 12 boys and 8 girls. Thirteen had prenatal ultrasound diagnosis at a mean gestational age of 23 weeks. The mean gestational age at delivery was 37 weeks, and mean birth weight was 2.5 kg. Nineteen had other anomalies and/or medical problems, 18 of them multiple. The most common was pulmonary hypoplasia (70%). Mechanical ventilation and/or oxygen treatment was required in 15 (75%) for a mean of 10 weeks. SSD was used as primary sac treatment in 5 and secondary treatment in 15 (after Silon pouch 11, Op-site 3, povidone-iodine 1). Six omphalocele sacs were ruptured within the first 5 days of life. SSD was used for a mean of 6 months at a cost of $1 per day. Complications included 2 instances of staphylococcal sepsis and 1 jejunal perforation inside a Silon pouch. Six (30%) died from pulmonary hypoplasia at a mean age of 18 weeks. There were 14 (70%) survivors who went home after a mean of 14 weeks. Of the 14 survivors, 12 had ventral hernias repaired (18 operations with 2 recurrences), and 2 remain with their original ventral hernia.

CONCLUSIONS

Initial topical coverage with SSD is associated with excellent outcomes for infants with giant omphalocele who cannot undergo immediate closure.

摘要

背景/目的：评估局部磺胺嘧啶银（SSD）乳膏在治疗巨大脐膨出婴儿中的价值。

方法

1991 年至 2008 年，20 例巨大脐膨出（定义为直径>10cm）婴儿采用 SSD 治疗，留下大的腹疝待日后修复。

结果

男 12 例，女 8 例。13 例产前超声诊断，平均孕周 23 周。平均分娩孕周为 37 周，平均出生体重为 2.5kg。19 例有其他畸形和/或医学问题，其中 18 例为多种畸形。最常见的是肺发育不良（70%）。15 例（75%）需要机械通气和/或吸氧，平均 10 周。SSD 用于 5 例原发性囊治疗，15 例（Silon 囊 11 例，Op-site 3 例，聚维酮碘 1 例）继发性治疗。6 例脐膨出囊在生命的前 5 天内破裂。SSD 平均使用 6 个月，每天费用 1 美元。并发症包括 2 例葡萄球菌败血症和 1 例 Silon 囊内空肠穿孔。6 例（30%）因肺发育不良死亡，平均年龄为 18 周。14 例（70%）幸存者平均 14 周后出院。14 例幸存者中，12 例行腹疝修复（18 例手术，2 例复发），2 例仍保留原腹疝。