Nuchtern J G, Baxter R, Hatch E I
Department of Surgery, Children's Hospital and Medical Center, Seattle, WA 98105, USA.
J Pediatr Surg. 1995 Jun;30(6):771-6. doi: 10.1016/0022-3468(95)90745-9.
Giant omphalocele is a major clinical challenge for pediatric surgeons. Whereas small- to medium-sized defects can be repaired primarily, larger omphaloceles cannot be closed at birth because the liver and small bowel have lost the right of domain to the abdomen. Two divergent strategies have evolved for treating these giant defects: (1) use of a silon chimney with gradual reduction of the contents of the sac, and (2) initial nonoperative management (epithelialization) of the omphalocele followed by repair of the residual ventral hernia. In an 18-year retrospective study, we have reviewed our experience with these treatment methods. Ninety-four infants underwent treatment for omphalocele between 1975 and 1993. Primary closure (PC) was possible in 55 patients, silon chimney (SC) was used in 15, and 7 had nonoperative management (NM) with epithelialization. In the remaining 17 infants, surgery was believed to be inappropriate because of the lethality of their associated anomalies. Major (but potentially survivable) anomalies were present in 26% of PC, 13% of SC, and 71% of the NM group patients. The majority of the liver was present in 73% of SC- and 86% of NM-treated omphaloceles. There was a decrease in length of stay, time to enteral feeding, and mortality over the 18-year period. However, those patients whose defects could not be closed primarily had consistently longer hospital stays. This was particularly true for the SC patients. The decreased use of total parenteral nutrition seems to reflect a shift from SC to NM rather than a decrease in the interval to full enteral feeding in any given treatment group over time.(ABSTRACT TRUNCATED AT 250 WORDS)
巨大脐膨出对小儿外科医生来说是一项重大的临床挑战。中小型脐膨出缺损可直接修复，而较大的脐膨出在出生时无法闭合，因为肝脏和小肠已失去在腹腔内的正常位置。针对这些巨大缺损，已形成两种不同的治疗策略：（1）使用硅酮烟囱法逐步减少囊内容物；（2）对脐膨出进行初始非手术处理（上皮化），随后修复残余的腹侧疝。在一项为期18年的回顾性研究中，我们回顾了我们使用这些治疗方法的经验。1975年至1993年间，94例婴儿接受了脐膨出治疗。55例患者可行一期缝合（PC），15例使用硅酮烟囱法（SC），7例采用非手术处理（NM）并实现上皮化。其余17例婴儿因合并严重畸形被认为不宜手术。PC组、SC组和NM组分别有26%、13%和71%的患者存在严重（但可能存活）的畸形。在接受SC治疗的脐膨出中，73%存在大部分肝脏；在接受NM治疗的脐膨出中，86%存在大部分肝脏。在这18年期间，住院时间、开始肠内喂养的时间和死亡率均有所下降。然而，那些缺损无法一期闭合的患者住院时间一直较长。SC组患者尤其如此。全胃肠外营养使用的减少似乎反映了从SC法向NM法的转变，而非随着时间推移在任何特定治疗组中完全肠内喂养间隔时间的缩短。（摘要截断于250字）
