横向低位与中线腹部皮肤切口在胎儿脊柱裂修复中的应用比较。
Low Transverse versus Midline Abdominal Skin Incisions for in utero Spina Bifida Repair.
机构信息
The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
Department of Pediatric Surgery, McGovern Medical School - University Health Science Center at Houston, The Fetal Center and the Memorial Hermann Hospital, Houston, Texas, USA.
出版信息
Fetal Diagn Ther. 2021;48(3):174-182. doi: 10.1159/000512045. Epub 2021 Feb 16.
OBJECTIVE
The 2 types of maternal skin incisions for in utero spina bifida repair are low transverse (LT) incision perceived to be cosmetic benefit and midline longitudinal (ML) incision, typically associated with a reduction in surgical time and lower blood loss. Our objective was to compare short- and long-term outcomes associated with these 2 types of skin incisions following in utero spina bifida repair.
METHODS
Prospective observational cohort of 72 patients undergoing fetal spina bifida repair at a single institution between September 2011 and August 2018. The decision for the type of incision was at the discretion of the surgeons. The primary outcome was total operative time. Secondary outcomes included an analog scale of wound pain score on postoperative day 3, duration of postoperative stay, and postoperative wound complications within the first 4 weeks. The Patient Scar Assessment Questionnaire, a validated questionnaire, was obtained for all patients (≥6 months from delivery) using 4 categories (appearance, consciousness, satisfaction with appearance and with symptoms), with higher scores reflecting a poorer perception of the scar.
RESULTS
There were 43 women (59.7%) in the LT group and 29 (40.3%) in the ML group. In all patients, the same incision was used during cesarean delivery. The total operative time was higher in the LT group by 33 min (p < 0.001), primarily due to abdominal wall incision time (open and closure). No significant differences were found between the groups in pain score, length of postoperative stay, or the rate of wound complications. Fifty-three patients (73.6%) responded to the questionnaire, 36/43 from the LT group and 17/29 from the ML group. There was no difference in the scores of appearance, consciousness, and satisfaction with appearance and symptoms between the groups.
CONCLUSION
ML incisions shorten operative times without altering long-term incision-related satisfaction when compared to LT incisions.
目的
用于宫内脊柱裂修复的两种类型的产妇皮肤切口为横向（LT）切口，被认为具有美容优势，以及中线纵向（ML）切口，通常与手术时间缩短和出血量减少相关。我们的目的是比较这两种类型的切口在宫内脊柱裂修复后短期和长期的结果。
方法
这是一项在 2011 年 9 月至 2018 年 8 月期间在一家机构进行的胎儿脊柱裂修复的前瞻性观察队列研究。切口类型的选择由外科医生决定。主要结果是总手术时间。次要结果包括术后第 3 天的伤口疼痛评分模拟量表、术后住院时间以及术后 4 周内的伤口并发症。使用 4 个类别（外观、意识、对外观和症状的满意度）获得了所有患者（分娩后≥6 个月）的患者疤痕评估问卷，该问卷是一个经过验证的问卷，较高的分数反映了对疤痕的较差感知。
结果
LT 组中有 43 名女性（59.7%），ML 组中有 29 名女性（40.3%）。在所有患者中，剖宫产时使用了相同的切口。LT 组的总手术时间长 33 分钟（p <0.001），主要是由于腹壁切口时间（切开和关闭）。两组之间的疼痛评分、术后住院时间或伤口并发症发生率无显著差异。53 名患者（73.6%）对问卷做出了回应，LT 组 36 名，ML 组 17 名。两组在外观、意识以及对外观和症状的满意度评分方面没有差异。
结论
与 LT 切口相比，ML 切口缩短了手术时间，而不会改变长期切口相关的满意度。
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