Yu Simiao,Ma Lishuang,Wang Ying,et al.Prenatal evaluations and postnatal diagnosis and treatment of congenital diaphragmatic hernia[J].Journal of Clinical Pediatric Surgery,2020,19(05):441-446.[doi:10.3969/j.issn.1671-6353.2020.05.013]
新生儿膈疝胸腔镜治疗后存活率的影响因素分析
- Title:
- Prenatal evaluations and postnatal diagnosis and treatment of congenital diaphragmatic hernia
- Keywords:
- Hernia; Diaphragmatic/CN; Thoracoscopy; Therapy; Survival Rate; Infant; Newborn
- 分类号:
- R726;R655.6
- 摘要:
- 目的 先天性膈疝（congenital diaphragmatic hernia，CDH）是指因先天性膈肌结构缺损致腹腔内容物疝入胸腔。本研究旨在总结首都儿科研究所附属儿童医院近5年入院诊断为CDH患儿的临床资料，分析CDH患儿生存率的影响因素，为患儿产前及生后病情评估提供循证依据，进而提高CDH患儿诊疗技术。方法 本组患儿经产科儿科产前咨询，新生儿外科医生产房待产，生后经绿色通道转运至我中心SNICU，由新生儿外科与超声科、NICU、心脏外科等多学科对患儿进行围术期的联合诊疗，首选胸腔镜治疗。结果 2014年4月至2019年12月经我中心普通（新生儿）外科诊治的58例CDH患儿中，42例行胸腔镜手术修补膈肌，35例存活，7例死亡，死亡率占总经治量的12%，其中6例为胸腔镜手术中转为开放手术，4例存活，2例死亡，死亡率占总经治量3%；13例行开放手术修补膈肌，5例存活，8例死亡。另有3例产前诊断发现CDH，术前死亡。存活患儿与死亡患儿在产前诊断孕周、住院时间、有创通气时间、手术时机及手术方式上比较差异存在统计学意义（P<0.05）。结论 胸腔镜手术在新生儿CDH治疗中安全可行。产前诊断时间、手术时机、手术方式是预测患儿预后情况的重要指标。
- Abstract:
- Objective Congenital diaphragmatic hernia (CDH) refers to a structural birth defect of diaphragmatic defect.We performed a retrospective analysis and summarized the experiences of thoracoscopy for neonatal diaphragmatic hernia.Methods All children received prenatal consultations at the departments of obstetrics and pediatrics.Neonatal surgeons waited for delivery in delivery room.The children were transferred into SNICU of our center through a green channel of critical newborn transport.The departments of neonatal surgery and ultrasound,NICU,cardiac surgery and other disciplines formulated treatment plans.Thoracoscopy was preferred.After operation,neonatal surgeons continued perioperative treatment in NICU.Results From April 2014 to July 2019,there were 42 thoracoscopic cases of neonatal diaphragmatic hernia.35 children survived and 7 died.6 cases were converted into open surgery.2 cases survived and another 2 died.Among 13 cases of open repairing,5 survived and 8 died.And 3 cases of CDH were prenatally diagnosed and died preoperatively.The mean postnatal operative time was (30±16) hours,the mean postoperative time of invasive ventilator (5±2) days and the mean hospital stay (21±13) days.After discharge,follow-ups were conducted at outpatient service or by telephone for 1 to 60 months.After pulmonary function exercises,respiratory functions recovered well. The development and activity levels were similar to those of normal same-age children.Conclusion Thoracoscopic surgery is safe and feasible in neonatal CDH treatment. Prenatal diagnosis time,operation timing, operation mode are important indicators to predict the prognosis of children.
参考文献/References:
1 Tovar JA.Congenital diaphragmatic hernia[J].Orphanet J Rare Dis,2012,7(1):1.DOI:10.1186/1750-1172-7-1.
2 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.
3 Puligandla PS,Skarsgard ED,Offringa M,et al.Diagnosis and management of congenital diaphragmatic hernia:a clinical practice guideline[J].CMAJ,2018,190(4):E103-E112.DOI:10.1503/cmaj.170206.
4 Morini F,Valfre L,Capolupo I,et al.Congenital diaphragmatic hernia:defect size correlates with developmental defect[J].J Pediatr Surg,2013,48(6):1177-1182.DOI:10.1016/j.jpedsurg.2013.03.011.
5 Bouchghoul H,Senat MV,Storme L,et al.Congenital diaphragmatic hernia:does gestational age at diagnosis matter when evaluating morbidity and mortality?[J].Am J Obstet Gynecol,2015,213(4):531-535.DOI:10.1016/j.ajog.2015.06.012.
6 Gentili A,Pasini L,Iannella E,et al.Predictive outcome indexes in neonatal Congenital Diaphragmatic Hernia[J].J Matern Fetal Neonatal Med,2015,28(13):1602-1607.DOI:10.3109/14767058.2014.963043.
7 Sitkin NA,Ozgediz D,Donkor P,et al.Congenital anomalies in low-and middle-income countries:the unborn child of global surgery[J].World J Surg,2015,39(1):36-40.DOI:10.1007/s00268-014-2714-9.
8 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].临床小儿外科杂志,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.
9 Snoek KG,Reiss IK,Greenough A,et al.Standardized Postnatal Management of Infants with Congenital Diaphragmatic Hernia in Europe:The CDH EURO Consortium Consensus-2015 Update[J].Neonatology,2016,110(1):66-74.DOI:10.1159/000444210.
10 Chandrasekharan PK,Rawat M,Madappa R,et al.Congenital Diaphragmatic hernia-a review[J].Matern Health Neonatol Perinatol,2017,3(1):6.DOI:10.1186/s40748-017-0045-1.
11 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.
相似文献/References:
[1]王勇,汤绍涛,毛永忠,等.腔镜下手术治疗小儿膈肌疾病31例[J].临床小儿外科杂志,2010,9(06):441.
[2]寿铁军李勇马能强龚晟.腹腔镜手术治疗小儿腹股沟斜疝1582例[J].临床小儿外科杂志,2011,10(01):0.
[3].小儿先天性腰疝治疗分析[J].临床小儿外科杂志,2010,9(04):0.
GUO Zheng-tuan,XU Quan,LI Peng,et al.Diagnosis and management of congenital lumbar hernias in children.[J].Journal of Clinical Pediatric Surgery,2010,9(05):0.
[4]唐志贤,余家康,王凤华,等.地塞米松对先天性膈疝胎鼠肺发育的影响[J].临床小儿外科杂志,2008,7(01):8.
[5]浦征宇,潘永康,段光琦,等.小儿腹股沟嵌顿性斜疝合并阑尾炎的临床分析[J].临床小儿外科杂志,2008,7(01):37.
[6]葛午平,俞钢,朱小春,等.新生儿小型脐膨出的产前诊断与手法复位治疗[J].临床小儿外科杂志,2008,7(04):0.
[7]杜宝峰,易军,刘继炎,等.腹腔镜治疗复发性斜疝58例[J].临床小儿外科杂志,2008,7(04):0.
[8]王剑锋,刘国庆,唐华建,等.腹腔镜下网片修补小儿巨大腹股沟斜疝的初步报告[J].临床小儿外科杂志,2007,6(01):31.
[9]唐剑平,何东北,唐向东,等.腹腔镜下小儿腹股沟斜疝高位结扎术45例[J].临床小儿外科杂志,2007,6(01):24.
[10]归奕飞,韦勇杰,王奇,等.一孔法腹腔镜手术治疗小儿嵌顿性腹股沟斜疝[J].临床小儿外科杂志,2007,6(02):8.
[11]朱琳琳吕志葆陈 功肖现民.腹腔镜下U型缝合膈肌缺损治疗儿童先天性胸骨后疝[J].临床小儿外科杂志,2010,9(03):0.
ZHU Lin-lin,LV Zhi-bao,CHEN Gong,et al.Laparoscopic-assisted full-thickness anterior abdominal wall repair of Morgagni hernia in children.[J].Journal of Clinical Pediatric Surgery,2010,9(05):0.
[12]丁 锋 黄 姗 杨星海.先天性膈疝35例诊治体会[J].临床小儿外科杂志,2013,12(02):128.[doi:10.3969/j.issn.1671— 6353.2013.02.015]
DING Feng,HUANG Shan,YANG Xin-hai.Experience of diagnosis and treatment of congenital diaphragmatic hernia:report of 35 cases[J].Journal of Clinical Pediatric Surgery,2013,12(05):128.[doi:10.3969/j.issn.1671— 6353.2013.02.015]
[13]吴雨昊,况虹宇,吕铁伟,等.微创手术及开放手术治疗先天性膈疝效果的Meta分析[J].临床小儿外科杂志,2017,16(01):18.
[14]欧宗青,夏波,唐晶,等.先天性膈疝诊治专题·论著·产前诊断先天性膈疝79例治疗与结局分析[J].临床小儿外科杂志,2017,16(01):26.
[15]张智恩,郑珊,董瑞,等.新生儿先天性膈疝诊治及预后相关因素分析——单中心近10年经验总结[J].临床小儿外科杂志,2017,16(01):31.
[16]刘威,汪凤华..膈疝复发的原因分析及处理[J].临床小儿外科杂志,2017,16(01):41.
[17]赵萍,刘翔,左伟,等.胸腔镜手术治疗新生儿先天性膈疝复发的影响因素分析及其对复发膈疝的治疗效果[J].临床小儿外科杂志,2021,20(02):153.[doi:10.12260/lcxewkzz.2021.02.009]
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,2021,20(05):153.[doi:10.12260/lcxewkzz.2021.02.009]
备注/Memo
收稿日期:2019-05-28。
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：XTZD20180305）；国家重点研发计划基金资助项目（编号：2018YFC1002503）；3.北京市卫生与健康科技成果和适宜技术推广项目基金资助项目（编号：2018-TG-51）
通讯作者:马立霜,Email:malishuang2006@sina.com