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,2021,20(09):819-824.[doi:10.12260/lcxewkzz.2021.09.004]
胸腔镜手术治疗先天性膈疝的经验及技术要点分析
- Title:
- Key technical essentials and experiences during thoracoscopy for congenital diaphragmatic hernia
- Keywords:
- Hernias; Diaphragmatic; Congenital/SU; Thoracoscopy
- 分类号:
- R655.6;R726.1
- 摘要:
- 目的 总结分析胸腔镜手术治疗先天性膈疝的技术要点。方法 回顾性分析首都儿科研究所附属儿童医院2014年4月至2021年4月采用胸腔镜手术治疗的59例先天性膈疝患者临床资料，包括出生体重、出生孕周、产前诊断孕周、膈疝位置等，对其手术后治疗情况及手术操作经验进行总结。结果 59例新生儿先天性膈疝患者中，产前诊断54例（91.5％），生后诊断5例（8.5%）。左侧膈疝49例，右侧膈疝10例。产前诊断胎龄为（26.9±5.1）周，其中小于25周的患者共25例，年龄最小为孕18周。平均出生孕周为（37.0±2.3）周，范围为28.0~41.0周；出生孕周小于37周15例，最小出生孕周为28周。平均出生体重为（2.89±0.60）kg，范围为1.36~4.10 kg；出生体重1.5~2.5 kg 12例，出生体重低于1.5 kg 2例，最低出生体重1.36 kg。59例均采用胸腔镜手术，其中51例（86.4%）顺利完成胸腔镜手术，8例（13.6%）胸腔镜手术中转开腹手术。总体存活51例（86.4％），死亡8例（13.6％）；其中胸腔镜手术患者存活46例，存活率90.2%（46/51）；胸腔镜中转开腹手术存活5例，存活率62.5%（5/8）。应用补片修补8例（13.6%），其中胸腔镜手术患者应用补片修补4例，胸腔镜中转开腹手术患者应用补片修补4例。术后复发4例（6.8%），其中胸腔镜手术后复发3例（5.9%，3/51），胸腔镜中转开腹手术后复发1例（12.5%，1/8）。结论 胸腔镜手术治疗新生儿先天性膈疝时应操作轻柔，紧密缝合缺损膈肌，达到手术指征时可优先考虑胸腔镜手术，术中心肺功能难以维持时应尽快中转开放手术。
- 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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备注/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