Alemayehu Hanna, Sola Richard, Le Nhatrang H, Juang David, Aguayo Pablo, Fraser Jason D, St Peter Shawn D
Department of Surgery, The Children's Mercy Hospital , Kansas City, Missouri.
J Laparoendosc Adv Surg Tech A. 2018 Jun;28(6):751-754. doi: 10.1089/lap.2017.0301. Epub 2018 Feb 22.
The vertical transumbilical incision (TU) technique during neonatal abdominal exploration involves dissection and ligation of umbilical vessels, which allow access to all quadrants of the abdomen and complete bowel evisceration with minimal violation to the anterior abdominal wall. We compared patient characteristics and outcomes for neonates undergoing TU with standard transverse exploration.
A single-center retrospective review of neonates who underwent abdominal exploration between January 2010 and September 2015 was conducted after obtaining Institutional Review Board approval. Data included patient demographics, indication for operative intervention, operative details, complications, including incisional hernias, and long-term outcomes.
There were 88 neonates under 4 months of age who underwent abdominal exploration, with a median age of 5.5 ± 17 days and a median gestational age of 32.8 ± 16 weeks. Exploration was emergent in 38 patients (43%) and 49 (56%) required ostomy formation. A transverse incision (TV) was used in 30 patients and a TU in 58 patients. Both groups had similar postoperative complication rates; 27 (47%) in the TU group and 11 (36%) in the TV group, P = .51. Median length of follow-up in the TU group was 5.1 ± 18 months and 6.2 ± 16 months in the TV group, P = .48. The TU group had 4 incisional/umbilical hernias (7%), none have required repair.
TUs for abdominal explorations in neonates have similar outcomes as the standard TV while preserving the integrity of the anterior abdominal wall.
新生儿腹部探查术中的垂直经脐切口（TU）技术涉及脐血管的解剖和结扎，该技术可进入腹部的所有象限，并能在对前腹壁造成最小损伤的情况下完全暴露肠管。我们比较了接受TU手术的新生儿与接受标准横向探查的新生儿的患者特征和手术结果。
在获得机构审查委员会批准后，对2010年1月至2015年9月期间接受腹部探查的新生儿进行了单中心回顾性研究。数据包括患者人口统计学资料、手术干预指征、手术细节、并发症（包括切口疝）以及长期结果。
88例4个月以下的新生儿接受了腹部探查，中位年龄为5.5±17天，中位胎龄为32.8±16周。38例（43%）为急诊探查，49例（56%）需要造口术。30例患者采用横向切口（TV），58例患者采用TU。两组术后并发症发生率相似；TU组为27例（47%），TV组为11例（36%），P = 0.51。TU组的中位随访时间为5.1±18个月，TV组为6.2±16个月，P = 0.48。TU组有4例切口/脐疝（7%），均无需修复。
新生儿腹部探查采用TU与标准TV的手术结果相似，同时保留了前腹壁的完整性。
