目的 探讨新生儿腹壁切口完全性裂开的病因、预防及治疗措施。 方法 回顾性分析本院2009年6月至2015年6月收治的211例新生儿开腹手术临床资料,其中5例发生腹壁切口完全性裂开,日龄2～28 d,体重1.9～3.5 kg,男性4例,女性1例,足月儿3例,早产儿2例,横切口2例,纵切口3例。5例均为消化道疾病的手术,其中小肠造瘘术2例,肠切除肠吻合术1例,肠修补术1例,ladd及阑尾切除术1例。 结果 211例新生儿开腹手术患儿中,发生切口完全性裂开5例,切口裂开率为2.4%,且均为消化道疾病。1例肠造瘘及肠吻合、修补术患儿第1次手术中有肠内容物污染腹腔; 1例行ladd及阑尾切除术患儿再次缝合切口时腹腔探查见结扎阑尾的线头脱落,腹腔内可见脓性分泌物,但未见阑尾残端瘘。5例患儿经扩创再缝合后全部治愈,无再裂开现象发生,无死亡病例。术后随访6～12个月无切口疝,切口愈合良好。 结论 新生儿腹壁切口完全性裂开是剖腹手术后一种严重的并发症,发生后需紧急处理。避免新生儿腹壁切口完全性裂开主要在于提高认识,积极预防,减少诱发因素。
Objective To explore the cause, treatment and prevention of entire abdominal wound disruption in neonates. Methods From June 2009 to June 2015, retrospective analysis was performed for the clinical data of 211 laparotomic cases. There were 5 cases of entire abdominal wound disruption. There were 4 boys and 1 girl with an age range of 2-28 days and a weight range of 1.9-3.5 kg. The neonates were term(n=3)and premature(n=2). And the incisions were transverse(n=2)and longitudinal(n=3). The procedures included intestinal fistula(n=2), intestinal resection of intestinal anastomosis(n=1), intestinal repair(n=1)and Ladd & appendectomy(n=1). Results The incision dehiscence rate was 2.4%. All 5 cases were of gastrointestinal diseases. In 1 case, during initial intestinal fistula and anastomosis, intestinal contents contaminated abdominal cavity. And in another case, during Ladd and appendectomy re-exploration, laparotomy revealed a loosening of ligation with intraperitoneal purulent secretion. All 5 cases were cured by expansion and suturing. During a follow-up period of 6 to 12 months, there was on onset of incisional hernia and wounds healed well. Conclusion Entire abdominal wound disruption is a serious complication requiring emergency treatment in neonates. For its prevention, attention should be paid to raising awareness and minimizing precipitating factors.
