Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, China.
World J Pediatr. 2018 Aug;14(4):399-403. doi: 10.1007/s12519-018-0129-7. Epub 2018 Mar 5.
To determine whether ex utero intrapartum treatment (EXIT) is an appropriate approach for managing fetuses antenatally diagnosed with giant congenital omphaloceles.
We retrospectively reviewed patients with omphaloceles who underwent either an EXIT procedure or a traditional repair surgery. Basic and clinical parameters including gender, gestational age, birth weight, maternal blood loss, operative times and operative complications were analyzed. During the 6-12-month follow-ups, postoperative complications including bowel obstruction, abdominal infections, postoperative abdominal distension were monitored, and survival rate was analyzed.
A total of seven patients underwent the EXIT procedure and 11 patients underwent the traditional postnatal surgery. We found no differences in maternal age, gestational age at diagnosis, gestational age at delivery and birth weight between the two groups. In the EXIT group, the average operation time for mother was 68.3 ± 17.5 minutes and the average maternal blood loss was 233.0 ± 57.7 mL. The operation time in the EXIT group (22.0 ± 4.5 minutes) was shorter than that in the traditional group (35 ± 8.7 minutes), but the length of hospital stay in the EXIT group (20.5 ± 3.1 days) was longer than that in the traditional group (15.7 ± 2.5 days, P < 0.05). During the follow-up, one patient in the EXIT group had an intestinal obstruction, one developed abdominal compartment syndrome and one died in the traditional group.
In our experience, EXIT is a safe and effective procedure for the treatment of giant congenital omphaloceles. However, more experience is needed before this procedure can be widely recommended.
为了确定宫外产时治疗（EXIT）是否是处理产前诊断为巨大先天性脐膨出胎儿的合适方法。
我们回顾性分析了接受 EXIT 手术或传统修复手术的脐膨出患者。分析了基本和临床参数，包括性别、胎龄、出生体重、产妇出血量、手术时间和手术并发症。在 6-12 个月的随访中，监测了包括肠梗阻、腹部感染、术后腹胀在内的术后并发症，并分析了存活率。
共有 7 例患者接受了 EXIT 手术，11 例患者接受了传统的产后手术。我们发现两组患者的母亲年龄、诊断时的胎龄、分娩时的胎龄和出生体重均无差异。在 EXIT 组，母亲的平均手术时间为 68.3±17.5 分钟，平均产妇出血量为 233.0±57.7 毫升。EXIT 组的手术时间（22.0±4.5 分钟）短于传统组（35±8.7 分钟），但 EXIT 组的住院时间（20.5±3.1 天）长于传统组（15.7±2.5 天，P<0.05）。在随访期间，EXIT 组有 1 例发生肠梗阻，1 例发生腹腔间隔室综合征，传统组有 1 例死亡。
根据我们的经验，EXIT 是治疗巨大先天性脐膨出的一种安全有效的方法。然而，在广泛推荐这种方法之前，还需要更多的经验。
