剖宫产同时行新生儿先天性腹裂修复1例报告  

A Case of Congenital Gastroschisis Repair of a Newborn Following the Cesarean Section

作　　者：苏留莉 陈荞薇 周颖 林卫[1,2] SU Liu-li;CHEN Qiaowei;ZHOU Ying;LIN Wei(Department of Obstetrics and Gynecology,West China Second University Hospital,Sichuan University,Chengdu 610041,China;Key Laboratory of Birth Defects and Related Women and Children Diseases of the Ministry of Education(Sichuan University),Chengdu 610041,China)

机构地区：[1]四川大学华西第二医院妇产科,成都610041 [2]出生缺陷与相关妇儿疾病教育部重点实验室(四川大学),成都610041

出　　处：《四川大学学报（医学版）》2020年第5期732-734,共3页Journal of Sichuan University(Medical Sciences)

摘　　要：患者,女性,21岁,因"停经35+4周,胎动消失1 d"入院。孕30周在院外胎儿系统彩超提示:胎儿腹裂畸形。孕32+1周在我院腹部针对彩超示:胎儿腹壁回声连续性中断4.5 cm,肠管及部分内脏漂浮于羊膜腔内,考虑胎儿发育异常(腹裂畸形)。此次来我院行胎儿监护示无应激试验(NST)无反应型,以"胎儿宫内窘迫"收入院。入院后孕妇及家属选择行剖宫产及产时即行新生儿先天性腹裂修复手术,术前请麻醉科、新生儿科、小儿外科等相关科室会诊,于全麻下行剖宫产术,娩出一活女婴。胎儿娩出后,由小儿外科同时行产时手术,术后患儿腹壁张力稍高,但未明显影响通气,术后转新生儿科,予禁食、补液、胃肠减压、抗感染等治疗,患儿腹胀逐渐减轻,予肠内营养无不适后出院。随访至今,患儿生长发育尚可,无切口感染、裂开、肠坏死、腹壁疝等并发症。对于先天性腹裂,应完善孕期检查,早期诊断,及时将腹裂胎儿的孕母转诊至有条件的医院,以便对有Ⅰ期修复条件的腹裂患儿施行产时手术或早期行Ⅰ期修复手术,改善患儿预后,降低病死率。A 21-year-old woman was admitted at 35+4 weeks due to disappearance of fetal movement for one day. The ultrasound from other hospital indicated fetal gastroschisis. Abdominal ultrasound in our hospital confirmed that the discontinuity of the fetal abdominal wall by 4.5 cm. The stomach and part of the intestine were herniating into the amniotic cavity. Considering the possibility of gastroschisis and fetal distress, electronic fetal monitoring was implemented continuously and consultations of relevant departments were called immediately, including anesthesiology,neonatology and general pediatric surgery. After Cesarean section under general anesthesia, pediatric surgeons performed an intrapartum surgery for the neonate. The tension of abdominal wall was slightly higher after the operation, but had no significant negative effect on ventilation. After surgery, the neonate was transferred to neonatal pediatrics for further treatments. The abdominal distention of the neonate relieved gradually. The patient was discharged after receiving full enteral nutrition without any discomfort. It was found in the follow-up that the patient had no discomforts such as infection, wound dehiscence, intestinal necrosis, abdominal hernia or other complications. The prenatal examinations should be completed and the pregnant mother of gastroschisis fetus should be transferred to the experienced center where the intrapartum surgery or early stage I repair surgery is possible for the neonate.

关 键 词：剖宫产 腹裂 产时手术 Ⅰ期修复手术 

分 类 号：R722.1[医药卫生—儿科] R719.8[医药卫生—临床医学]