Fonkalsrud E W, Smith M D, Shaw K S, Borick J M, Shaw A
Division of Pediatric Surgery, University of California, Los Angeles School of Medicine.
Ann Surg. 1993 Dec;218(6):742-7. doi: 10.1097/00000658-199312000-00007.
This study analyzed the factors influencing the postoperative results after the repair of gastroschisis defects during the past 27 years.
The clinical results after the repair of gastroschisis abdominal defects have improved appreciably during the past 25 years, with the long-term survival rate in most large children's centers currently being approximately 90%. The improvement in survival has been largely attributed to advances in perioperative care, frequent use of parenteral nutrition, and better techniques of surgical repair.
Between 1965 and 1992, 84 infants with gastroschisis underwent surgical repair. The management of 52 infants after 1979 was compared with that of 32 during the previous 14 years. Associated anomalies were present in 29%. The average birth weight was 2412 g. In 31%, primary fascial closure was performed. In another 31% with moderate visceroabdominal disproportion (VAD), a silastic chimney was used initially, and complete repair was performed at a second operation. For 25% who had severe VAD, more than two operative reconstructions were necessary. Seven of 52 infants with moderate VAD underwent initial skin-flap closure and secondary repair within 12 days.
Almost all complications (27%) and deaths (4%) occurred in infants with severe VAD and were largely unrelated to associated malformations or birth weight. The length of postoperative mechanical ventilation, need for parenteral nutrition, need for multiple operations, and length of hospitalization were all directly related to the severity of the VAD.
Complete repair of gastroschisis at the initial operation is the optimal goal; however, the severity of VAD has permitted this approach in only one third of patients in this study. Delayed repair with a silastic chimney and one or more reconstructive procedures has provided excellent long-term survival with low morbidity and mortality rates. Although skin-flap closure is no longer used initially, this technique has been helpful for the residual defect in infants with severe VAD who have had multiple silon chimney repairs (Applied Biomaterial, Silverdale, WA).
本研究分析了过去27年中影响腹裂缺损修复术后结果的因素。
在过去25年里，腹裂腹部缺损修复后的临床结果有了显著改善，目前大多数大型儿童中心的长期存活率约为90%。存活率的提高很大程度上归因于围手术期护理的进步、肠外营养的频繁使用以及更好的手术修复技术。
1965年至1992年间，84例腹裂婴儿接受了手术修复。将1979年后52例婴儿的治疗情况与前14年的32例进行了比较。29%的患儿存在相关畸形。平均出生体重为2412克。31%的患儿进行了一期筋膜缝合。另外31%有中度内脏腹壁比例失调（VAD）的患儿，最初使用硅橡胶烟囱，在第二次手术时进行完全修复。25%有严重VAD的患儿需要进行两次以上的手术重建。52例中度VAD患儿中有7例在12天内进行了一期皮瓣闭合和二期修复。
几乎所有并发症（27%）和死亡（4%）都发生在严重VAD的婴儿中，且在很大程度上与相关畸形或出生体重无关。术后机械通气时间、肠外营养需求、多次手术需求以及住院时间均与VAD的严重程度直接相关。
初次手术时完全修复腹裂是最佳目标；然而，在本研究中，只有三分之一的患者因VAD的严重程度而允许采用这种方法。使用硅橡胶烟囱进行延迟修复以及一次或多次重建手术，已实现了低发病率和死亡率的良好长期存活率。虽然最初不再使用皮瓣闭合，但该技术对接受多次硅橡胶烟囱修复的严重VAD婴儿的残余缺损有帮助（应用生物材料公司，华盛顿州银戴尔）。
