Gomes Ferreira Cindy, Lacreuse Isabelle, Geslin Dorothée, Schmitt Françoise, Schneider Anne, Podevin Guillaume, Becmeur François
Department of Pediatric Surgery, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, 67098, France,
Pediatr Surg Int. 2014 Mar;30(3):305-11. doi: 10.1007/s00383-013-3440-3. Epub 2013 Dec 12.
The aim of this study is to analyze the effectiveness of an Alexis wound retractor (AWR) device for staged gastroschisis closures.
AWR device was used to cover unreduced viscera of a gastroschisis when primary abdominal wall closure was not convenient. The eviscerated organs were covered with one of the two spring-loaded rings of the AWR inserted underneath the abdominal wall. Gradual reduction was guaranteed through careful traction on the external ring. We retrospectively analyzed the prenatal, post-natal and operative data of the first patients treated with AWR and report their post-operative outcomes.
The AWR device was used for staged closure in eight cases. Complete reduction and fascial closure were performed at a median of 3.5 ± 1.6 days. Ventilatory support was necessary for 4.0 ± 3 days and full parenteral feeds for 7.5 ± 6.1 days after fascial closure. Median full enteral feeding was observed at 18 ± 12.5 days after closure allowing discharge in a median period of 30.5 ± 15.6 days after closure.
The AWR device is not only a safe and efficient silo for a progressive reduction of severe gastroschisis, but also an interesting tool for continuous stretching leading to an increase of the peritoneal cavity volume, enhancing the equalizing of the viscero-abdominal disproportion.
本研究旨在分析Alexis伤口牵开器（AWR）装置用于分期关闭腹裂的有效性。
当一期腹壁关闭不便时，使用AWR装置覆盖腹裂未还纳的内脏。将AWR的两个弹簧加载环之一插入腹壁下方以覆盖脱出的器官。通过小心牵拉外环确保逐步还纳。我们回顾性分析了首例接受AWR治疗患者的产前、产后及手术数据，并报告其术后结果。
AWR装置用于8例分期关闭。在中位时间3.5±1.6天进行完全还纳和筋膜关闭。筋膜关闭后，通气支持需要4.0±3天，全胃肠外营养需要7.5±6.1天。中位完全肠内喂养在关闭后18±12.5天出现，允许在关闭后中位时间30.5±15.6天出院。
AWR装置不仅是一种安全有效的用于逐步还纳严重腹裂的“袋状装置”，也是一种用于持续拉伸以增加腹腔容积、促进内脏与腹部比例均衡的有趣工具。
