Kogut Kelly A, Fiore Nicholas F
Sunrise Children's Hospital, Las Vegas, NV.
Sunrise Children's Hospital, Las Vegas, NV.
J Pediatr Surg. 2018 Dec;53(12):2404-2408. doi: 10.1016/j.jpedsurg.2018.08.018. Epub 2018 Sep 2.
We describe our series of giant omphalocele patients treated with a serial taping method for gradual reduction of the abdominal contents and early fascial closure.
Between 2010 and 2017 we cared for ten newborns with giant omphaloceles. The average gestational age was 35.5 weeks (range 29-38) and average birthweight was 2.84 kg. Seven infants had other major anomalies, including one with a variant of Pentology of Cantrell. Four had abnormal chromosomes. None had any attempt to primarily close the defect. Omphalocele defects were serially taped at bedside in the NICU with the child awake until the viscera were completely reduced, and the defect could be closed.
Mean time to closure was 13.7 days (median 14 days). Six were closed primarily without a patch. The remaining four infants required Gore-Tex patch (covered by skin) which was later removed and fascia closed in three infants (at 70 days, 75 days, and 11 months of age). Total length of stay was a mean 71.8 days (median 71).
Serial taping achieves early fascial closure and avoids complications of a staged surgical approach, such as multiple anesthetics, loss of fascial margin integrity, silo dehiscence, and fistula formation. Compression of the viscera is slow enough to avoid abdominal compartment syndrome and the fascia and amnion are left intact leaving the option available to use escharotic agents if required.
Treatment study.
Level III.
我们描述了一系列采用连续包扎法治疗巨大脐膨出患者的经验，该方法可逐步还纳腹腔内容物并早期关闭筋膜。
2010年至2017年间，我们诊治了10例巨大脐膨出的新生儿。平均胎龄为35.5周（范围29 - 38周），平均出生体重为2.84千克。7例婴儿有其他主要畸形，其中1例患有坎特雷尔五联症变异型。4例染色体异常。所有患儿均未尝试一期关闭缺损。在新生儿重症监护病房（NICU）床边，于患儿清醒状态下对脐膨出缺损进行连续包扎，直至内脏完全还纳且缺损能够关闭。
平均关闭时间为13.7天（中位数14天）。6例一期关闭，未使用补片。其余4例婴儿需要使用戈尔特斯补片（后被皮肤覆盖），其中3例婴儿（分别在70天、75天和11个月大时）后期移除补片并关闭筋膜。总住院时间平均为71.8天（中位数71天）。
连续包扎可实现早期筋膜关闭，避免分期手术的并发症，如多次麻醉、筋膜边缘完整性丧失、袋状皮瓣裂开和瘘管形成。内脏受压速度足够缓慢，可避免腹腔间隔室综合征，且筋膜和羊膜保持完整，如有需要可选择使用腐蚀剂。
治疗性研究。
三级。
