Chen Yichu,Pi Mingan.Surgical treatment of neonatal diaphragmatic hernia[J].Journal of Clinical Pediatric Surgery,,18():1049-1052.[doi:10.3969/j.issn.1671-6353.2019.12.012]
Surgical treatment of neonatal diaphragmatic hernia
- Keywords:
- Hernia; Diaphragmatic/CN; Thoracoscopes; Surgical Procedures; Operative; Therapy; Methods; Comparative Study; Infant; Newborn
- CLC:
- R726;R655.6
- Abstract:
- Objective To explore the surgical approaches and perioperative managements of congenital diaphragmatic hernia (CDH) in neonates and summarize the relevant clinical experiences.Methods From January 2012 to June 2017,retrospective analysis was performed for the clinical data of 48 hospitalized CDH neonates.According to different surgical approaches,they were divided into two groups of open surgery and endoscopy.Early-stage (prior to 2014) conventional thoracic surgery was performed (n=21); after 2014,thoracoscopy (n=27) and transit thoracotomy (n=6).Two groups were compared with regards to age,weight,concurrent malformations,preoperative therapy,surgical approaches and postoperative complications.Results The overall curative rate was 79.17% (38/48).Thoracoscopy (n=21) and transit thoracotomy (n=6) were performed.The outcomes were discharge after thoracoscopy (n=2) and mortality in intensive care unit (n=2).And the curative rate was 80.95% (17/21).Thoracotomy (n=21) was performed.Six children died postoperatively and the curative rate was 71.43% (15/21).There was no significant inter-group difference (P>0.05).As for operative duration,ventilator-assisted time and hospitalization duration,the differences were statistically significant (P<0.05).Reexpansion pulmonary edema (n=4 vs.6) and pneumothorax (n=2 vs.1) occurred in thoracoscopy and thoracotomy groups respectively.There was no significant inter-group difference (P>0.05).Finally 38 children survived.During a follow-up period of 6-36 months,the prognosis was excellent and no recurrence.Conclusion Neonatal mortality remains high for severe CDH.Early surgery and proper mechanical ventilation are vital for improving its survival rate.
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Memo
收稿日期:2018-07-12。
基金项目:武汉市卫生健康委员会卫生科研项目（编号：WX14C54）
通讯作者:皮名安,Email:18672352752@163.com