Liu Qin,Ren Hongyan,Wang Mingxue,et al.Value of multiple ultrasonic indicators in estimating the outcomes of congenital diaphragmatic hernia[J].Journal of Clinical Pediatric Surgery,,():550-554.[doi:10.3760/cma.j.cn101785-202309036-008]
Value of multiple ultrasonic indicators in estimating the outcomes of congenital diaphragmatic hernia
- Keywords:
- Hernias; Diaphragmatic; Congenital; Ultrasonography; Forecasting; Prognosis
- Abstract:
- Objective To explore the value of multiple ultrasound indicators in the prognosis evaluation of congenital diaphragmatic hernia and provide scientific rationales for an accurate diagnosis and treatment of congenital diaphragmatic hernia (CDH). Methods From January 2018 to December 2022,preoperative ultrasonic images were retrospectively reviewed for 92 CDH children undergoing neonatal surgery.The relevant indicators included length of diaphragmatic defect (≤4 cm & >4 cm),location of liver (liver hernia & non liver hernia) and gastric vesicles (left/right),hernia sac (yes or no) and whether or not lung ultrasound was abnormal.According to their prognosis,they were divided into two groups of death and survival.And the relationship between each indicator and the prognosis of children (death or survival) was statistically examined. Results Among them,70 survived and 22 died with a case fatality rate of 23.9%.Comparing survival group with death group,the difference in the proportion of herniation into liver[(25.7%(18/70) vs.54.5%(12/22)],presence of hernial sacs [survival group:72.9%(51/70),death group:50.0%(11/22)]and presence of ultrasonographic abnormality in lungs [survival group:48.6%(34/70),death group:81.8%(18/22)] were statistically significant (all P<0.05).Multivariate Logistic regression analysis indicated that diaphragmatic defect length >4 cm (OR=4.513,95%CI:1.120-18.184),liver herniation into chest (OR=3.636,95%CI:1.171-11.290),lung ultrasonic abnormalities (OR=3.640,95%CI:1.022-12.963) and an absence of hernia sac (OR=3.428,95%CI:1.066-11.025) were risk factors for a poor prognosis of CDH.Kappa values for diaphragmatic defect length >4 cm,liver herniation into chest,absence of hernia sac and lung ultrasonic abnormalities were <0.6 whereas Kappa value for a combination of these four parameters was 0.788. Conclusions Diaphragmatic defect length,liver location,hernia sac and lung function may be employed as prognostic indicators for CDH children.And a combination of the above four parameters can more accurately predict the outcomes of CDH children.
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Memo
收稿日期:2023-09-20。
基金项目:北京市医院管理局儿科专项重点项目子课题(XTZD20180305)
通信作者:马立霜,Email:malishuang2006@sina.com