小儿外科畸形早期外科干预新途径—产房外科的可行性VIP免费

�98�临床儿科杂志2005年第23卷第2期小儿外科畸形早期外科干预新途径�产房外科的可行性上海第二医科大学附属新华医院小儿外科(上海200092)施诚仁蔡威王俊杨祖菁*王捍平葛莉张弛潘伟华*妇产科通讯作者:施诚仁Email:shicr@citiz.net�论著�摘要!目的探讨小儿外科畸形早期外科干预的一种新途径,即产房内外科纠治的可行性。方法通过文献复习及对近期开展的2例临床外科纠治病例的治疗进行可行性分析。例1:1例巨大脐膨出儿孕妇产前34周经B超及MRI得到明确诊断,因预估脐膨出腹壁缺损范围达7cm,故产房剖腹产后即行全身评估,同时插胃管及渐加压将脱出内脏回纳腹内,2h后I期手术修补成功。例2:34周孕妇产前B超诊断胎儿腹部有巨大囊肿,36周胎儿囊肿缩小,腹水增加,阴囊增大、积水5cm∀5cm,提示囊肿破裂。遂决定37周行剖腹产终止妊娠,患儿体重3800g,经全身评估后剖腹探查发现回肠闭锁,近端肠管穿孔,弥漫性胎粪腹膜炎,但未形成钙化灶,右阴囊积液。行部分肠段切除,近端小肠造瘘,远端Bishop术式端侧肠吻合,囊肿壁切除,阴囊及腹部引流。结果2例患儿均手术成功。结论#产房内外科纠治畸形手术是可行的。∃产房外科优点在于外来感染机会少,属零转运;胃肠道气体少对腹壁缺损关闭有利;及早干预去除病因,中断了病理状态进一步发展;越早手术切口疤痕反应小,及早纠治畸形消除了家长精神上痛苦。关键词!外科畸形产房外科脐膨出肠闭锁中图分类号!R726文献标识码!A文章编号!1000-3606(2005)02-098-03Anovelapproachtotreatneonatalabnormalitiesintheirearlierstage-Feasibilityofthede�liveryroomsurgerysystemShiChengren,CaiWei,WangJun,YangZujing,WangHanping,GeLi,ZhangChi,PanWeihua.DepartmentofPediatricSurgery,DepartmentofObstetrics,XinHuaHospitalAffiliatedtoShanghaiSecondMedicalUniversity,Shanghai200092Abstract!ObjectiveDeliveryroomsurgeryisanovelapproachtotreatneonateswithbirthdefectsintheirearlierstage.Thisreportdiscussthefeasibilityofthedeliveryroomsurgerysystemanddefineitsmechanismasbeingasurgicalinterventionperformedinthedeliveryroomtotreatthenewborninfantswithaprenataldiagnosisofcongenitaldefectimmediatelyafterthedelivery.MethodsThefeasibilityofdeliveryroomsurgerywasanalyzedthroughbothoftheliteraturesreviewandthedeliveryroomsurgeryontwocasesperformed.ResultsCase1,a39_week_gestationnewborninfant,whowasantenatallydiagnosedassevereomphalocelewith7cmdefectoftheabdominalwallat28,36and38weeksofthegestationalagede�tectedbyultrasonographyandMRI,wassuccessfullyperformedtheone_stage_closureoftheabdominalwallathistwo_hourageafterroutinepreoperativeexaminationincludedECG,serumelectrolytesandbloodgasimmediatelyafterbirth.Case2,agiantabdominalcystwasfoundinafetuswith34weeksofgestationduringprenatalroutineultrasound.By36thweekofgestation,theultrasonographicfindingsshowedtheshrundencyst,theswelledscrotumandtheincreasedintraperitonealfluid,indicatingtheruptureoftheabdominalcyst.Withtheassociateddiscussionofpediatricsurgeonsandobstetricians,thepregnancywasdeterminedtoterminateat37thweekofgestation.Theneonatewithabirthweightof3800gunderwentthelaparotomyafterroutinepreoperativeexaminationimmediatelyafterbirth.Ileumatresiawasdiagnosedandmeconiumperitonitisduetoperforationoftheproximalsegmentoftheileum(pseudo_cyst)wasfoundduringthela�parotomy.Abishopenterostomywasperformedafterthecleanupofthemeconiumandthepseudo_cyst.ConclusionsItisconcludedthat(1)thesurgicalinterventionperformedinthedeliveryroomwasfeasible.(2)Notransportationrequiredintheobstetricsurgerysystem,theinfectionrateduetoenvironmentalcon�taminationcouldhencebecontrolledtominimum.(3)Theearliertheoperation,thelesstheintra_intestinalgasexisted,whichwasnodoubttheadvan...