Horiike Masaki, Kitada Tomohiro, Santo Kenji, Hashimoto Takuro, Satoshi Onishi
Department of Pediatric Surgery, Japanese Red Cross Society, Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama, Wakayama, 640-8558, Japan.
Department of Surgery, Matsushitakai, Shiraniwa Hospital, 6-10-1, Shiraniwa-dai, Ikoma, Nara, 630-0136, Japan.
Int J Surg Case Rep. 2020;75:464-468. doi: 10.1016/j.ijscr.2020.09.096. Epub 2020 Sep 17.
A giant omphalocele (GO) with marked viscero-abdominal disproportion is associated with surgical difficulty and higher morbidity and mortality rates. Despite various treatment strategies, no consensus exists on optimal GO management. We report the clinical course of a neonate with a GO who was successfully treated with abdominal-wall closure through the novel application of collagen-based artificial dermis (CAD) for epithelization.
A female neonate (estimated gestational age, 38 weeks; birthweight, 3.047 kg) with a GO where most viscera, including the liver, were completely herniated. G-band analysis showed no chromosomal abnormality and normal karyotype. Conventional silo formation was attempted, but incomplete silo was formed due to adhesion between the portal vein and fascia, and repatriation of the herniated viscera had not progressed. A new silo was formed using biomaterial, but it was infected and removed. Abdominal wall epithelialization using NPWT was attempted again but was interrupted by the occurrence of jejunal perforation. After incising the epithelialized part of the abdominal wall and repairing the perforated jejunum, the GO was covered and fixed using CAD. Epithelialization progressed well, and she was discharged on day 328.
In this case, the major therapeutic challenges (including formation of an incomplete silo, silo infection, and jejunal perforation) were overcome with conventional treatment except for epithelialization of the abdominal wall, which was achieved by using CAD.
The treatment with CAD for epithelialization can be considered in cases where it is extremely difficult to return the viscera in conventional management.
巨大脐膨出（GO）伴有明显的内脏-腹壁比例失调，手术难度大，发病率和死亡率较高。尽管有多种治疗策略，但对于GO的最佳管理尚无共识。我们报告了一名患有GO的新生儿的临床过程，该患儿通过新型应用基于胶原蛋白的人工真皮（CAD）进行上皮化成功实现腹壁闭合治疗。
一名女婴（估计孕周38周；出生体重3.047千克）患有GO，包括肝脏在内的大部分内脏完全疝出。G带分析显示无染色体异常，核型正常。尝试进行传统的袋状缝合法，但由于门静脉与筋膜之间的粘连形成了不完全的袋状结构，疝出内脏的回纳未取得进展。使用生物材料形成了一个新的袋状结构，但发生感染后被移除。再次尝试使用负压伤口治疗（NPWT）进行腹壁上皮化，但因空肠穿孔而中断。切开腹壁上皮化部分并修复穿孔的空肠后，使用CAD覆盖并固定GO。上皮化进展顺利，患儿于第328天出院。
在本病例中，除腹壁上皮化通过使用CAD实现外，传统治疗克服了主要的治疗挑战（包括不完全袋状结构的形成、袋状结构感染和空肠穿孔）。
在传统管理中内脏回纳极其困难的情况下，可考虑使用CAD进行上皮化治疗。
