Wei Yandong,Ma Lishuang,Wang Ying,et al.Key technical essentials and experiences during thoracoscopy for congenital diaphragmatic hernia[J].Journal of Clinical Pediatric Surgery,,20():819-824.[doi:10.12260/lcxewkzz.2021.09.004]
Key technical essentials and experiences during thoracoscopy for congenital diaphragmatic hernia
- Keywords:
- Hernias; Diaphragmatic; Congenital/SU; Thoracoscopy
- CLC:
- R655.6;R726.1
- Abstract:
- Objective To summarize the technical points of thoracoscopic surgery for congenital diaphragmatic hernia. Methods From April 2014 to April 2021, retrospective review was performed for clinical data of 59 children with congenital diaphragmatic hernia (CDH) undergoing thoracoscopy, including birth weight, gestational age at birth, gestational age at prenatal diagnosis and sideness of CDH.And postoperative profiles were recorded.Results Among them, 54 cases (91.5%) were diagnosed prenatally and 5 cases (8.5%) postnatally.The involved side was left (n=49) and right (n=10).The average gestational age of prenatal diagnosis was (26.9±5.1) weeks.For 25 children, the gestational age of prenatal diagnosis was ≤ 25.0 weeks and the minimum 18 weeks.The average gestational age at birth was (37.0±2.3)(28.0-41.0) weeks.In another 15 cases, the gestational age at birth was <37 weeks and the minimal gestational age at birth 28 weeks.The average birth weight was (2.89±0.60)(1.36-4.10) kg.For 12 cases with a birth weight of 1.5-2.5kg.The birth weight was <1.5 kg in 2 cases and the minimal birth weight 1.36 kg.The specific procedures included thoracoscopy ongenital diaphragmatic hernia underwent thoracoscopy (n=51, 86.4%) and a conversion into open surgery (n=8, 13.6%).The overall outcomes were survival (n=51, 86.4%) and death (n=8, 13.6%).And 46 thoracoscopic children survived with a survival rate of 90.2%(46/51) and another 5 laparotomic children had a survival rate of 62.5%(5/8).Patches were used in 8 cases (13.6%), including thoracoscopic (n=4) and laparotomic (n=4).Postoperative recurrence occurred in 4 cases (6.8%), including after thoracoscopy (5.9%, 3/51) and after laparotomy (12.5%, 1/8). Conclusion Thoracoscopy for CDH in neonates should be flexible and closely sutured.Converting into open surgery timely is required if cardiopulmonary status becomes unstable.
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Memo
收稿日期:2021-07-03。
基金项目:北京市儿科学科协同发展中心儿科专项基金资助项目（编号：XTGL201912）
通讯作者:马立霜,Email:malishuang2006@sina.com