Komuro H, Imaizumi S, Hirata A, Matsumoto M
Department of Surgery, Saitama Children's Medical Center, Japan.
J Pediatr Surg. 1998 Mar;33(3):485-8. doi: 10.1016/s0022-3468(98)90093-8.
The optimal surgical approach for gastroschisis remains controversial, although primary closure after vigorous stretching of the abdominal wall and decompression of the intestinal contents is currently preferred.
Between 1984 and 1997, 24 newborns with gastroschisis were treated at Saitama Children's Medical Center. The average gestational age was 37.3 weeks, and the average birth weight was 2,285 g. One patient had the associated anomaly of intestinal atresia and short bowel. Rupture of the intestines during delivery was noted in one patient. The authors applied their nonaggressive staged repair using a prosthetic silo with preservation of the umbilical cord in 20 of the 24 cases (83.3%). Primary closure with preservation of the umbilical cord was performed in the remaining four cases (16.7%). In these patients, the gastroschisis was mild.
In the 20 cases treated by staged repair, the average interval between the first and second operation was 9.8 days. Mechanical ventilation was not required in 16 of 20 (80%) patients treated by staged repair, or in two of four (50%) patients treated by primary repair. The number of days to the first feeding averaged 14.6 days in 23 cases, excluding the patient with short bowel syndrome who required continuous total parenteral nutrition (TPN). TPN through a central venous catheter was required in 3 of 23 patients (13.0%). The overall average hospital stay was 55.1 days. Survival was 24 of 24 or 100%. Complications included perforation of the intestines, gastric bleeding, ventral hernia, and wound infection. No infections were associated with the prosthetic silo. All of the patients had a satisfactory cosmetic outcome. Recent advances in neonatal intensive care, including antibiotic therapy, reduced the possibility of infection.
This staged repair of gastroschisis was simple and safe, neither requiring experienced surgical judgment nor complicated postoperative management, and achieved satisfactory results. Furthermore, preservation of the umbilical cord provided an improved cosmetic appearance.
尽管目前倾向于在强力拉伸腹壁并减压肠内容物后进行一期缝合，但腹裂的最佳手术方法仍存在争议。
1984年至1997年间，埼玉儿童医疗中心治疗了24例腹裂新生儿。平均孕周为37.3周，平均出生体重为2285克。1例患者伴有肠闭锁和短肠的相关畸形。1例患者在分娩时出现肠破裂。作者在24例中的20例（83.3%）应用了他们的非激进分期修复方法，使用带假体的脐膨出袋并保留脐带。其余4例（16.7%）进行了保留脐带的一期缝合。在这些患者中，腹裂较轻。
在接受分期修复的20例患者中，第一次和第二次手术之间的平均间隔为9.8天。接受分期修复的20例患者中的16例（80%）以及接受一期修复的4例患者中的2例（50%）不需要机械通气。23例患者（不包括需要持续全胃肠外营养（TPN）的短肠综合征患者）首次喂养的天数平均为14.6天。23例患者中有3例（13.0%）需要通过中心静脉导管进行TPN。总体平均住院时间为55.1天。24例患者全部存活，存活率为100%。并发症包括肠穿孔、胃出血、腹疝和伤口感染。没有感染与假体脐膨出袋相关。所有患者的美容效果都令人满意。包括抗生素治疗在内的新生儿重症监护的最新进展降低了感染的可能性。
这种腹裂分期修复方法简单安全，既不需要经验丰富的手术判断，也不需要复杂的术后管理，并且取得了令人满意的结果。此外，保留脐带改善了外观。
