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目的探讨产时胎儿手术在胎儿先天性腹壁缺损治疗中的可行性与优越性。方法选择2008—2016年中国医科大学附属盛京医院手术治疗的先天性腹壁缺损患儿46例,随访患儿治疗及预后情况,比较产时手术与择期手术治疗的患儿在短期及长期预后方面的差异。结果 12例腹裂患儿接受手术治疗,产时手术6例,择期手术6例,不同手术方式在Ⅰ期修补率、腹裂大小、术后感染等方面差异无统计学意义(P>0.05);产时手术组术后全肠外营养时间、住院时间方面明显短于择期手术组(P<0.05)。34例脐膨出患儿接受手术治疗,产时手术17例,择期手术17例,不同手术方式在治愈率、死亡率、Ⅰ期修补率、合并肝膨出率方面差异无统计学意义(P>0.05);产时手术组的膨出物明显大于择期手术组(P<0.05),术后感染率明显低于择期手术组(P<0.05),全肠外营养时间和住院时间明显短于择期手术组(P<0.05)。不同手术方式远期预后均无明显差异。结论产时胎儿手术在胎儿先天性腹壁缺损的治疗中具有可行性与优越性,能够明显改善患儿短期预后。
Objective To investigate the feasibility and superiority of labor-fetus fetus in the treatment of fetal congenital abdominal wall defects. Methods 46 children with congenital abdominal wall defect treated by Shengjing Hospital Affiliated to China Medical University during 2008-2016 were selected. The treatment and prognosis of children with follow-up were compared. The outcomes of patients who were treated by delivery or elective surgery were compared in terms of short-term and long-term prognosis The difference. Results There were no statistically significant differences between the two groups (P> 0.05). There were no significant differences in the rate of wound repair, The time of postoperative total parenteral nutrition and hospital stay in labor group was significantly shorter than that in elective surgery group (P <0.05). 34 cases of umbilical swelling in children undergoing surgical treatment, 17 cases of intrapartum surgery, elective surgery in 17 cases, the different surgical methods in the cure rate, mortality, Ⅰ repair rate, hepatic prolapse rate was no significant difference (P > 0.05). The incidence of bullae in the operation group was significantly higher than that in the elective operation group (P <0.05), and the postoperative infection rate was significantly lower than that in the elective operation group (P <0.05). The total parenteral nutrition time and hospital stay were significantly shorter Elective surgery group (P <0.05). Long-term prognosis of different surgical methods were no significant difference. Conclusion The fetus during labor during delivery is feasible and superior in the treatment of fetal congenital abdominal wall defects and can significantly improve the short-term prognosis of children.