新生儿腹壁切口完全性裂开的临床分析  

Clinical analysis of entire abdominal wound disruption in neonates

作　　者：段守兴[1] 王广欢[1] 钟军[1] 欧文辉[1] 符马贤 王富生[1] 许陈斌 陈凯洪 李建宏[1] 

机构地区：[1]广东省汕头大学医学院第二附属医院小儿外科,广东省汕头市515041

出　　处：《临床小儿外科杂志》2017年第6期601-603,616,共4页Journal of Clinical Pediatric Surgery

摘　　要：目的探讨新生儿腹壁切口完全性裂开的病因、预防及治疗措施。方法回顾性分析本院2009年6月至2015年6月收治的211例新生儿开腹手术临床资料,其中5例发生腹壁切口完全性裂开,日龄2～28 d,体重1.9～3.5 kg,男性4例,女性1例,足月儿3例,早产儿2例,横切口2例,纵切口3例。5例均为消化道疾病的手术,其中小肠造瘘术2例,肠切除肠吻合术1例,肠修补术1例,ladd及阑尾切除术1例。结果 211例新生儿开腹手术患儿中,发生切口完全性裂开5例,切口裂开率为2.4%,且均为消化道疾病。1例肠造瘘及肠吻合、修补术患儿第1次手术中有肠内容物污染腹腔;1例行ladd及阑尾切除术患儿再次缝合切口时腹腔探查见结扎阑尾的线头脱落,腹腔内可见脓性分泌物,但未见阑尾残端瘘。5例患儿经扩创再缝合后全部治愈,无再裂开现象发生,无死亡病例。术后随访6～12个月无切口疝,切口愈合良好。结论新生儿腹壁切口完全性裂开是剖腹手术后一种严重的并发症,发生后需紧急处理。避免新生儿腹壁切口完全性裂开主要在于提高认识,积极预防,减少诱发因素。Objective To explore the cause, treatment and prevention of entire abdominal wound dis- ruption in neonates. Methods From June 2009 to June 2015, retrospective analysis was performed for the clinical data of 211 laparotomic cases. There were 5 cases of entire abdominal wound disruption. There were g boys and 1 girl with an age range of 2 - 28 days and a weight range of 1.9 - 3.5 kg. The neonates were term （ n = 3 ） and premature （ n = 2 ）. And the incisions were transverse （ n=2 ） and longitudinal （ n = 3 ）. The pro- cedures included intestinal fistula （ n = 2）, intestinal resection of intestinal anastomosis （ n = 1 ）, intestinal repair （n = 1 ） and Ladd ＆ appendectomy （ n = 1 ）. Results The incision dehiscence rate was 2.4%. All 5 cases were of gastrointestinal diseases. In 1 case, during initial intestinal fistula and anastomosis, intestinal contents contaminated abdominal cavity. And in another case, during Ladd and appendectomy re-exploration, laparotomy revealed a loosening of ligation with intraperitoneal purulent secretion. All 5 cases were cured by ex- pansion and suturing. During a follow-up period of 6 to 12 months, there was on onset of incisional hernia and wounds healed well. Conclusion Entire abdominal wound disruption is a serious complication requiring e- mergency treatment in neonates. For its prevention, attention should be paid to raising awareness and minimizing precipitating factors.

关 键 词：腹部 外科伤VI裂开 婴儿 新生 

分 类 号：R726.5[医药卫生—儿科]