新生儿含肝组织的巨型脐膨出的临床治疗抉择探讨  

Investigation of proper treatment for giant omphalocele with liver protrusion in neonates

作　　者：熊晓峰[1] 鲁巍 邢福中[1] 余雷[1] 汪玥 王育继[2] 陈绪勇 周燕 Xiong Xiaofeng;Lu Wei;Xing Fuzhong;Yu Lei;Wang Yue;Wang Yuji;Chen Xuyong;Zhou Yan(Department of Neonate Surgery,Wuhan Children′s Hospital(Wuhan Maternal and Child Healthcare Hospital),Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430016,China;Department of Medical Record,Wuhan Children′s Hospital(Wuhan Maternal and Child Healthcare Hospital),Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430016,China;The Research Institute at Nationwide Children′s Hospital,Ohio State University,Columbus 43205,America;Department of Gynaecology and Obstetrics,Wuhan Children′s Hospital(Wuhan Maternal and Child Healthcare Hospital),Tongji Medical College,Huazhong University of Science and Techno-logy,Wuhan 430016,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院(武汉市妇幼保健院)新生儿外科,武汉430016 [2]华中科技大学同济医学院附属武汉儿童医院(武汉市妇幼保健院)信息科,武汉430016 [3]美国俄亥俄州立大学Nationwide儿童医院儿科研究所,哥伦布43205 [4]华中科技大学同济医学院附属武汉儿童医院(武汉市妇幼保健院)妇产科,武汉430016

出　　处：《中华实用儿科临床杂志》2021年第2期122-127,共6页Chinese Journal of Applied Clinical Pediatrics

基　　金：武汉市中青年医学骨干人才培养工程(武卫计(2013)35号);武汉市卫健委课题(WX09B10)。

摘　　要：目的回顾分析含有肝脏组织的巨型脐膨出(GO)的临床特征,探讨最佳治疗方式,改善预后,提高GO患儿救治率。方法收集2009年1月至2019年5月在武汉儿童医院新生儿外科住院的GO患儿,治疗方法包括:1.使用类似Silo袋的方法,分期手术;2.一期直接或联合补片修补;3.保守治疗2~8周后延期一期手术。收集的数据包括患儿孕周、性别、出生体质量、脐膨出直径、膨出物内容、合并畸形、治疗方法、呼吸机使用时间及临床结局。根据脐膨出的内容物,本组患儿分为肝脏膨出组和肝脏合并其他组织组,总结并比较不同组别临床基本资料及临床结局。结果16例患儿中,男9例,女7例。就诊时日龄1~2 d[(1.25±0.45)d],体质量(2.48±0.37)kg,孕周(36.23±1.17)周,脐膨出大小为5~15 cm,直径为(9.88±3.30)cm。肝脏膨出组7例(43.75%),其中一期修补6例,保守治疗延期手术1例。肝脏合并其他组织组9例,膨出物除肝脏外,还包括小肠、结肠、脾脏等组织,一期修补、保守治疗延期手术、使用Silo袋者各3例。肝脏膨出组及肝脏合并其他组织组中使用呼吸机的例数分别为3例(42.8%)及8例(88.89%),与肝脏膨出组比较,肝脏合并其他组织组使用呼吸机的OR值为5.143(95%CI:0.727~36.368),且应用呼吸机的时间更长[(106.25±69.36)h比(30.67±19.0)h,P=0.021]。肝脏膨出组无死亡病例,肝脏并其他组织组死亡3例。术后患儿随访3个月~4年,5例出现腹壁疝:肝脏膨出组1例(14.3%);肝脏合并其他组织组4例,去除死亡的3例后,其占比66.7%(4/6例)。结论含肝脏膨出的脐膨出患儿,需强调个体化治疗。孤立的肝脏膨出者预后好于肝脏并其他脏器膨出者。孤立性肝脏膨出,建议一期手术;并其他脏器膨出的肝脏膨出,在囊膜完整的情况下,建议保守治疗后延期手术。肝膨出时需要考虑合并副肝的可能性。Objective To investigate the proper choice and improve the survival rate in neonates suffering from giant omphalocele(GO)with liver protrusion by analyzing the clinical characteristics,different treatments and outcomes.Methods Neonates with GO admitted in Department of Neonatal Surgery in Wuhan Children′s Hospital were retrospected from January 2009 to May 2019.The treatment methods include:(1)repaired with similar silo-bag by staged operation;(2)one-stage repair with patch or not;(3)delayed repair by conservative treatment for some time(from 2 to 8 weeks)firstly.Data included gestational age,gender,birth weight,average diameter of omphalocele,contents of omphalocele,associated malformation,treatment method,duration of ventilator use and clinical outcome.These neonates were divided into 2 groups according to the contents of protrusion:group with liver protrusion and group with liver and other organs protrusion.Clinical data were summarized and compared between different groups.Results Sixteen cases were collected,including 9 males and 7 females.The average age was(1.25±0.45)d(1-2 days),the average birth weight was(2.48±0.37)kg,and pregnant week was(36.23±1.17)weeks.The average diameter of the omphalocele was(9.88±3.30)cm,ranging from 5 cm to 15 cm.Seven cases were belonged to the group with liver protrusion,cases undergone one-stage repair,delayed repair were 6 cases and 1 case,respectively.There were 9 cases in group with liver and other organs protrusion,and the protruded organs included liver,intestine,colon or spleen.Among them,cases needed one-stage repair,delayed repair and silo-bag repair were 3 cases,3 cases,3 cases,respectively.Cases needed respiratory machine were 3 cases(42.8%)and 8 cases(88.89%)in group with liver protrusion and group with liver and other organs protrusion,respectively.Neonates had a longer time of needing respiratory machine in group with liver protrusion,comparing with the neonates in group with liver and other organs protrusion[(30.67±19.0)h vs.(106.25±69.36)h,P=0.021],and

关 键 词：脐膨出 肝脏 手术 治疗 

分 类 号：R722.1[医药卫生—儿科]