目的 探讨一期手术治疗先天性严重腹壁缺损及术后腹腔内压力的变化。方法 对本中心2015年1月至2016年12月收治的15例一期手术治疗严重腹壁缺损的患儿临床资料进行回顾性分析。结果 全组患儿均采用一期修补术,术后24 h后腹腔压力开始明显下降,呼吸机支持时间22～364 h,肠功能恢复时间67～168 h。全组患儿术后均恢复到全肠内营养后出院,出院随访11～34个月。1例脐膨出患儿术后2个月患肺炎,因呕吐窒息死亡; 1例29周早产腹裂患儿术后长期喂养不耐受,经反复肠内、外营养支持后恢复; 1例脐膨出患儿术后3个月出现切口疝,其余病例均恢复良好。结论 严重腹壁缺损一期手术虽然部分面临腹压过高,但通过全面的围术期处理,长时间的肌松和呼吸机支持,很快能度过术后高腹压期,达到一期修复。
Objective To investigate the changes of intra-abdominal pressure of children with severe congenital abdominal wall deficits after one-stage operation. Methods Retrospectively analyze clinical data of 15 cases of children with severe congenital abdominal wall deficit who underwent one-stage operation between January 2015 and December 2016. Results The intra-abdominal pressure of all patients decreased significantly after 24 hours post-operation.The total respiratory support time differed from 22 hours to 364 hours and the total recovery time of intestinal function differed from 67 hours to 168 hours.All patients discharged after recovering total enteral nutrition,and then be followed up by 11 to 34 months.All patients recovered well with exception of 3 cases:one children died from vomiting and suffocation due to pneumonia after 2 months of post-operation; one premature infant who suffered from long-term feeding intolerance finally recovered after repeated enteral and external nutrition support; one children had incisional hernia after 3 months of post-operation. Conclusion Although there is a considerable risk of high intra-abdominal pressure after one-stage operation,children with severe congenital abdominal-wall deficit can quickly survive this period, and achieve phase I repairmen through comprehensive perioperative care, together with long-time application of muscle relaxant and ventilator support.
