临床小儿外科杂志2024，Vol.23Issue(12)：1133-1137,5.DOI:10.3760/cma.j.cn101785-202409081-005
产儿合作一体化管理模式诊治巨型脐膨出的临床研究
Childbirth cooperation integrated diagnosis and treatment of giant omphalocele
摘要
Abstract
Objective To explore the application of childbirth cooperative management model of giant omphalocele(GO).Methods From January 2020 to December 2023,prenatal,prenatal and postpartum treat-ment data were retrospectively reviewed for 76 GO neonates.During a follow-up period of(9-36)month,heal-ing of abdominal wall incision,feeding and growth were recorded.Results Prenatal ultrasonography offered a definite diagnosis and prenatal chromosome and genetic screening showed no abnormalities.As recommended by antepartum multi-disciplinary treatment(MDT),termination was performed for cloaca malformation(n=1),spinal malformation(n=1)and pedicle syndrome(n=1).And pregnancy was terminated due to complex heart malformation(n=2)and 71 cases continued pregnancy.In the whole group,capsule was wrapped in de-livery room.There were capsule rupture(n=2,antenatal and labor each),hypoglycemia on admission(n=1)and hypothermia(n=1).The whole group included intestinal malrotation(n=68),Meckel's diverticulum(n=2),atrial septal defects(n=6),ventricular septal defects(n=4),patent ductus arteriosus(n=8),e-sophageal atresia(n=2),diaphragmatic hernia(n=1),bronchopulmonary dysplasia(n=8)and pulmonary hypertension(n=10).The interventions included conservative measures(n=7),primary repair(n=35),second stage repair(n=27),staged repair(n=2)and combined surgery(n=3,diaphragmatic hernia,n=1;esophageal atresia,n=2).There were NEC(n=1),pneumonia atelectasis(n=5),incision infection(n=3)and intestinal obstruction(n=5)(hepatic caudate lobe compression during conservative period,n=1;intesti-nal adhesion during conservative treatment,n=1;adhesive intestinal obstruction post-operation,n=3).During treatment period,66 patients were discharged and 5 died in hospital(pulmonary hypertension,n=1;cardiac insufficiency,n=1;severe pneumonia,n=2;abdominal space syndrome,n=1).During follow-ups,death was due to accidental vomiting & asphyxia(n=1)and severe pneumonia from gastroesophageal reflux(n=1).Two cases of pulmonary hypertension were transferred to external hospital for treatment and the remainders re-covered well.Conclusions The above integration mode may provide early interventions and effective manage-ments of neonatal GO.关键词
疝,脐/学科间信息交流/妊娠结局/治疗结果/疾病管理Key words
Hernia,Umbilical/Interdisciplinary Communication/Pregnancy Outcome/Treatment Out-come/Disease Management引用本文复制引用
吕成杰,王鹏,马东,赖登明,陈正,应力阳,谭征,王利权,钭金法..产儿合作一体化管理模式诊治巨型脐膨出的临床研究[J].临床小儿外科杂志,2024,23(12):1133-1137,5.基金项目
浙江省自然科学基金(LY22H040006) Zhejiang Provincial Natural Science Foundation(LY22H040006) （LY22H040006）
