Becmeur F, Dreyfus M, Langer B, Baldauf J J, Favre R, Sauvage P
Service de Chirurgie Infantile, Hôpital de Hautepierre, Strasbourg.
J Gynecol Obstet Biol Reprod (Paris). 1995;24(5):565-9.
Demonstrate the need for a multidisciplinary antenatal approach to laparoschisis.
A retrospective series of 50 children who underwent surgery for laparoschisis between 1975 and 1994 in the Infant Surgery Department of the Strasbourg University Hospitals. Postoperative outcomes were evaluated as a function of the stage of laparoschisis and surgical technique. Follow-up was also examined.
Depending on the periods evaluated, ultrasound diagnosis varied from 16 to 92% and was made at 21 weeks gestation on the average. Lesions observed were atresia of the bowel (10%), complete intestinal involution (2%), and perivisceritis (88%). Complete parietal closure was achieved after bowel emptying in 58% of the newborns. Postoperative mortality, usually in vere severe forms, fell from 46% to 15% over the 20-years study period.
Antenatal echography can confirm the diagnosis of laparoschisis. It can be used to define risk factors (size, bowel dilatation(s), mesenteric blood flow) allowing planned extraction in an Infantile Surgery Unit. This multidisciplinary attitude should help to improve overall outcome.
证明对先天性腹壁裂需要采取多学科产前治疗方法。
对1975年至1994年间在斯特拉斯堡大学医院小儿外科接受先天性腹壁裂手术的50例患儿进行回顾性研究。根据先天性腹壁裂的阶段和手术技术对术后结果进行评估。同时也对随访情况进行了检查。
根据所评估的时期，超声诊断率从16%到92%不等，平均在妊娠21周时做出诊断。观察到的病变有肠闭锁（10%）、完全性肠退缩（2%）和内脏周围炎（88%）。58%的新生儿在肠道排空后实现了完全的腹壁闭合。在20年的研究期内，术后死亡率（通常为非常严重的形式）从46%降至15%。
产前超声检查可确诊先天性腹壁裂。它可用于确定风险因素（大小、肠扩张、肠系膜血流），以便在小儿外科进行有计划的分娩。这种多学科方法应有助于改善总体治疗效果。
