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【摘要】 目的 总结和分析31例脐膨出合并多种畸形的临床特征和外科治疗方法。方法 对31例脐膨出合并多种畸形的临床特征和外科治疗资料进行分析,其中巨型18例;小型13例;14例合并各种先天性畸形共17种23畸次;2例巨型脐膨出合并美克尔憩室,此点与国外文献报道不甚一致;3例合并低血糖,其中1例为脐膨出合并巨舌巨体综合征;12例巨型脐膨出采用血氧饱和度监测下,无菌手套+涤纶片修补,分期治疗巨型脐膨出,不需术后呼吸机辅助呼吸,获得成功。结果 小型脐膨出13例(除1例合并5种畸形家长放弃治疗死亡外),均采用一期腹壁修补术治愈。巨型脐膨出12/18治愈。结论 小型脐膨出可采用一期腹壁修补术。巨型脐膨出,12例我们采用血氧饱和度监测下无菌手套+涤纶片修补,分期治疗获得成功。本术式不需术后呼吸机辅助呼吸,安全、经济,适合基层医院使用。
【关键词】脐膨出;美克尔憩室;无菌手套修补
Clinical treatment 31 cases of acromphalus
CHEN Yu-xi.Surgery department of Zhangzhou health professional school,Zhangzhou 363000,China
【Abstract】 Objective To summarize and analyze clinical feature and surgical treatment of 30 cases of acromphalus affiliate deformity.Methods 31cases of acromphalus affiliate deformity,18 cases giant and 13 small.14 cases of acromphalus affiliate deformity,17 kinds and 23 times,2 cases giant affiliate Meckel diverticulum,which report disconformity with abroad literature.3 cases affiliate glycopenia,one of which complicating with Beckwih-Wiedemen syndrome.Staging closure of 12 giant cases using sterile gloves and terylene patch under oxygen saturation monitoring without postoperation respirator.Results 13small cases cured by primary closure,except that 1 affiliate with 5 kinds of deformity was given by his parents.Cure rate of giant acromphalus is 12/18.Conclusion Small acromphalus can be cured by primary closure.Giant acromphalus can be cured by staging closure using sterile gloves and terylene patch under oxygen saturation monitoring without postoperation respirator,which is a safe,reliable and economic treatment suitable for basic level hospital.
【Key words】Acromphalus; Meckel diverticulum; Sterile gloves and terylene patch
脐膨出是一种先天性腹壁发育不全,脐带周围腹壁各层缺损,伴腹腔内脏脱出体外的先天性畸形。我科自1986年1月至2009年3月共收治31例,报告如下。
1 临床资料
1.1 一般资料 均为出生半小时~2个月的婴儿,男18例,女13例。早产儿7例;第2胎4例,其母第1胎均为自然流产;余为第1胎足月顺产儿。
1.2 合并畸形 31例中14例合并各种先天畸形。其中肠旋转不良4例,美克尔憩室3例,(2例为巨型脐膨出),隐睾2例,卵黄管未闭2例,脐尿管未闭1例,高位肛门闭锁1例,直肠膀胱瘘1例,回肠重复畸形1例,阴阜缺如1例,大阴唇缺如1例,肛门前移1例,房缺1例,先天性智力低下1例,食道裂孔滑疝1例,下腹壁缺如1例,耻骨分 离 1例。最多1例患儿合并5种畸形 。
1.3 合并内科疾病 低血糖3例;新生儿肺炎2例;败血症3例,共8例。
1.4 根椐腹壁缺损环直径大小分类,其中巨型脐膨出(≥5cm)18例,小型脐膨出(
