胎儿先天性腹壁缺损产时处理及预后探讨

摘要

Objective To explore the feasibility and superiority of intrapartum fetal operation in congenital abdominal wall defect.Methods We collected 46 cases of congenital abdominal wall defect with surgery in shengjing hospital from 2008 to 2016,and followed up the treatment and prognosis of these children in order to compare the differences between intrapartum fetal operation and elective operation in the short-term and long-term outcomes.Results 12 cases of gastroschisis were treated with surgery,consisting of 6 cases of intrapartum fetal operation and 6 cases of elective surgical procedures,there is no statistical significance in stage Ⅰ repair rate,gastroschisis size and postoperative infection between different surgical methods (P＞0.05);The group of intrapartum fetal operation is significantly shorter than elective operation group in the length of hospital stay and time of total parenteral nutrition (P＜ 0.05).34 cases of omphalocele performed surgery,including 17 cases of intrpartum fetal operation and 17 cases undergoing elective operation,the differences between have no statistical significance in the cure rate,mortality rate,phase Ⅰ repair rate and bulging merged liver rate different ways of operations (P＞0.05).The bulging of omphalocele in intrapartum fetal operation group is bigger than the elective operation group (P ＜ 0.05),postoperative infection is significantly lower than elective operation group (P ＜ 0.05),and the total parenteral nutrition time and hospitalization time are significantly shorter than elective operation group (P＜ 0.05).However the long-term prognosis has no obvious difference in different operation methods.Conclusion The intrapartum fetal operation has the feasibility and the superiority in the treatment of congenital abdominal wall defect,which can greatly improve the short-term prognosis of children.%目的 探讨产时胎儿手术在胎儿先天性腹壁缺损治疗中的可行性与优越性.方法 选择2008-2016年中国医科大学附属盛京医院手术治疗的先天性腹壁缺损患儿46例,随访患儿治疗及预后情况,比较产时手术与择期手术治疗的患儿在短期及长期预后方面的差异.结果 12例腹裂患儿接受手术治疗,产时手术6例,择期手术6例,不同手术方式在Ⅰ期修补率、腹裂大小、术后感染等方面差异无统计学意义(P＞O.05);产时手术组术后全肠外营养时间、住院时间方面明显短于择期手术组(P＜0.05).34例脐膨出患儿接受手术治疗,产时手术17例,择期手术17例,不同手术方式在治愈率、死亡率、Ⅰ期修补率、合并肝膨出率方面差异无统计学意义(P＞0.05);产时手术组的膨出物明显大于择期手术组(P＜0.05),术后感染率明显低于择期手术组(P＜0.05),全肠外营养时间和住院时间明显短于择期手术组(P＜0.05)..不同手术方式远期预后均无明显差异.结论 产时胎儿手术在胎儿先天性腹壁缺损的治疗中具有可行性与优越性,能够明显改善患儿短期预后.