Zhao Ping,Liu Xiang,Zuo Wei,et al.Analysis of influencing factors for recurrence after thoracoscopic repair of congenital diaphragmatic hernia in neonates and its treatment effect on recurrence[J].Journal of Clinical Pediatric Surgery,,20():153-160.[doi:10.12260/lcxewkzz.2021.02.009]
Analysis of influencing factors for recurrence after thoracoscopic repair of congenital diaphragmatic hernia in neonates and its treatment effect on recurrence
- Keywords:
- Thoracoscopy; Hernia; Diaphragmatic/CN; Diaphragmatic/CO; Recurrence; Infant; Newborn
- CLC:
- R655.6 R726.1
- Abstract:
- Objective To explore the relevant influencing factors of recurrence after thoracoscopic repair of congenital diaphragmatic hernia (CDH) in neonates and its treatment effect on recurrence.Methods Clinical data were analyzed retrospectively for 45 CDH neonates undergoing thoracoscopic repair from January 2013 to July 2019.The relevant factors related to postoperative recurrence were statistically analyzed.Results Eight cases recurred with a total postoperative recurrence rate of 17.8%.Preoperation 25% of them had both pulmonary hypertension and large patent ductus arteriosus (PDA) in recurrence group while none in non-recurrence group and the difference was statistically significant (P=0.03).The postoperative recurrence rate of CDH was significantly higher in children with large diaphragm defect (defect size ≥ 5 cm×4 cm) than that in those with small/medium diaphragm defect (defect size <5 cm×4 cm) (45.5% vs.8.8%) and the difference was statistically significant (χ2=5.329,P=0.02).From 2013 to 2015,the duration of surgery was significantly longer in recurrence group than that in non-recurrence group[(132.83±49.32) vs.(87.92±22.47) min] and the difference was statistically significant (t=2.779,P=0.01).And 1/8 recurrent cases died.Six children were cured after reoperation without secondary recurrence.One child still had recurrence after a second operation and became cured after a third operation.Conclusion Preoperative pulmonary hypertension plus large PDA,larger diaphragm defect with a size ≥ 5 cm×4 cm and longer surgery duration in early period of thoracoscopic learning curve are associated with higher recurrent hernia rate after thoracoscopic repair of CDH in neonates.
References:
1 Dingeldein M.Congenital diaphragmatic hernia:management & outcomes[J].Adv Pediatr,2018,65(1):241-247.DOI:10.1016/j.yapd.2018.05.001.
2 Liem NT,Nhat LQ,Tuan TM,et al.Thoracoscopic repair for congenital diaphragmatic hernia:experience with 139 cases[J].J Laparoendosc Adv Surg Tech A,2011,21(3):267-270.DOI:10.1089/lap.2010.0106.
3 Al-lede MM,Karpelowsky J,Fitzgerald DA.Recurrent diaphragmatic hernia:modifiable and non-modifiable risk factors[J].Pediatr Pulmonol,2016,51(4):394-401.DOI:10.1002/ppul.23305.
4 Weaver KL,Baerg JE,Okawada M,et al.A multi-institutional review of thoracoscopic congenital diaphragmatic hernia repair[J].J Laparoendosc Adv Surg Tech A,2016,26(10):825-830.DOI:10.1089/lap.2016.0358.
5 Criss CN,Coughlin MA,Matusko N,et al.Outcomes for thoracoscopic versus open repair of small to moderate congenital diaphragmatic hernias[J].J Pediatr Surg,2018,53(4):635-639.DOI:10.1016/j.jpedsurg.2017.09.010.
6 Kamran A,Zendejas B,Demehri FR,et al.Risk factors for recurrence after thoracoscopic repair of congenital diaphragmatic hernia (CDH)[J].J Pediatr Surg,2018,53(11):2087-2091.DOI:10.1016/j.jpedsurg.2018.04.007.
7 Silen ML,Canvasser DA,Kurkchubasche AG,et al.Video-assisted thoracic surgical repair of aforamen of Bochdalek hernia[J].Ann Thorac Surg,1995,60(2):448-450.DOI:10.1016/0003-4975(95)00100-y.
8 Liem NT.Thoracoscopic surgery for congenital diaphragmatic hernia:A report of nine cases[J].Asian J Surg,2003,26(4):210-212.DOI:10.1016/S1015-9584(09)60305-5.
9 Jancelewicz T,Langer JC,Chiang M,et al.Thoracoscopic repair of neonatal congenital diaphragmatic hernia (CDH):Outcomes after a systematic quality improvement process[J].J Pediatr Surg,2013,48(2):321-325.DOI:10.1016/j.jpedsurg.2012.11.012.
10 中华医学会小儿外科学分会内镜外科学组、心胸外科学组.先天性膈疝修补术专家共识及腔镜手术操作指南(2017版)[J].中华小儿外科杂志,2018,39(1):1-8.DOI:10.3760/cma.j.issn.0253-3006.2018.01.001. Section of Endoscopic Surgery,Section of Cardiothoracic Surgery,Branch of Pediatric Surgery,Chinese Medical Association.Consensus and endoscopic surgery guideline for congenital diaphragmatic hernia repair(2017 edition)[J].Chin J Pediatr Surg,2018,39(1):1-8.DOI:10.3760/cma.j.issn.0253-3006.2018.01.001.
11 Gander JW,Fisher JC,Gross ER,et al.Early recurrence of congenital diaphragmatic hernia ishigher after thoracoscopic than open repair:a single institutional study[J].J Pediatr Surg,2011,46(7):1303-1308.DOI:10.1016/j.jpedsurg.2010.11.048.
12 Costerus S,Zahn K,van de Ven K,et al.Thoracoscopic versus open repair of CDH in cardiovascular stable neonates[J].Surg Endosc,2016,30(7):2818-2824.DOI:10.1007/s00464-015-4560-8.
13 Hajer GF,vd Staak FH,de Hann AF,et al.Recurrent congenital diaphragmatic hernia:which factors are involved?[J].Eur J Pediatr Surg,1998,8(6):329-333.DOI:10.1055/s-2008-1071226.
14 Nagata K,Usui N,Terui K,et al.Risk factors for the recurrence of the congenital diaphragmatic hernia-report from the long-term follow-up study of Japanese CDH study group[J].Eur J Pediatr Surg,2015,25(1):9-14.DOI:10.1055/s-0034-1395486.
15 Putnam LR,Gupta V,Tsao K,et al.Factors associated with early recurrence after congenital diaphragmatic hernia repair[J].J Pediatr Surg,2017,52(6):928-932.DOI:10.1016/j.jpedsurg.2017.03.011.
16 Janssen S,Heiwegen K,van Rooij IA,et al.Factors related to long-term surgical morbidity in congenital diaphragmatic hernia survivors[J].J Pediatr Surg,2018,53(3):508-512.DOI:10.1016/j.jpedsurg.2017.05.032.
17 Lally KP,Lasky RE,Lally PA,et al.Standardized reporting for congenital diaphragmatic hernia-an international consensus[J].J Pediatr Surg,2013,48(12):2408-2415.DOI:10.1016/j.jpedsurg.2013.08.014.
18 陈功,郑珊.先天性膈疝诊治中的若干争议问题[J].临床小儿外科杂志,2017,16(1):8-11.DOI:10.3969/j.issn.1671-6353.2017.01.003. Chen G,Zheng S.Controversies over congenital diaphragmatic hernia[J].J Clin Ped Sur,2017,16(1):8-11.DOI:10.3969/j.issn.1671-6353.2017.01.003.
19 Tsai J,Sulkowski J,Adzick NS,et al.Patch repair for congenital diaphragmatic hernia:is it really a problem?[J].J Pediatr Surg,2012,47(4):637-641.DOI:10.1016/j.jpedsurg.2011.11.054.
20 陈义初,皮名安.不同手术方式治疗新生儿膈疝的对比研究[J].临床小儿外科杂志,2019,18(12):1049-1052.DOI:10.3969/j.issn.1671-6353.2019.12.012. Chen YC,Pi MA.Comparison of different surgical approaches for neonatal diaphragmatic hernia[J].J Clin Ped Sur,2019,18(12):1049-1052.DOI:10.3969/j.issn.1671-6353.2019.12.012.
21 黄金狮,陈快,戴康临,等.经胸腔镜手术治疗先天性膈疝的体会[J].中华小儿外科杂志,2012,33(5):340-343.DOI:10.3760/cma.j.issn.0253-3006.2012.05.006. Huang JS,Chen K,Dai KL,et al.Thoracoscopic repair of congenital diaphragmatic hernia[J].Chin J Pediatr Surg,2012,33(5):340-343.DOI:10.3760/cma.j.issn.0253-3006.2012.05.006.
22 于洁,张娜,陈诚豪,等.胸腔镜手术治疗非新生儿期先天性膈疝77例[J].临床小儿外科杂志,2017,16(2):155-158.DOI:10.3969/j.issn.1671-6353.2017.02.012. Yu J,Zhang N,Chen CH,et al.Thoracoscopic repair of congenital diaphragmatic hernia in non-neonates:a report of 77 cases[J].J Clin Ped Sur,2017,16(2):155-158.DOI:10.3969/j.issn.1671-6353.2017.02.012.
23 程千千,吴晔明,王俊,等.影响新生儿膈疝生存率的相关因素分析——开放手术与腔镜下手术比较[J].临床小儿外科杂,2019,18(3):237-241.DOI:10.3969/j.issn.1671-6353.2019.03.016. Cheng QQ,Wu YM,Wang J,et al.Analysis of related factors affecting neonatal sputum survival rate:comparison between open surgery and endoscopic surgery[J].J Clin Ped Sur,2019,18(3):237-241.DOI:10.3969/j.issn.1671-6353.2019.03.016.
24 Cha C,Hong YJ,Chang EY,et al.Minimally invasive surgery in infants with congenital diaphragmatic hernia:outcome and selection criteria[J].J Korean Surg Soc,2013,85(2):84-88.DOI:10.4174/jkss.2013.85.2.84.
25 何秋明,钟微,李乐,等.标准化指征下胸腔镜手术治疗新生儿先天性膈疝[J].中国微创外科杂志,2015,15(8):707-710.DOI:10.3969/j.issn.1009-6604.2015.08.011. He QM,Zhong W,Li L,et al.Outcomes of thoracoscopic repair of congenital diaphragmatic hernia in neonates under standardized indications[J].Chin J Min Inv Surg,2015,15(8):707-710.DOI:10.3969/j.issn.1009-6604.2015.08.011.
Memo
收稿日期:2020-03-23。
通讯作者:刘翔,Email:liuxiang-407@163.com