Zhang Yi,Ma Lishuang,Cao Ling,et al.Clinical observation of recent postoperative pulmonary function in patients with congenital phrenic hernia[J].Journal of Clinical Pediatric Surgery,2022,21(03):236-241.[doi:10.3760/cma.j.cn101785-202107030-007]
先天性膈疝患儿手术后近期肺功能观察及相关因素分析
- Title:
- Clinical observation of recent postoperative pulmonary function in patients with congenital phrenic hernia
- Keywords:
- Hernias; Diaphragmatic; Congenital/SU; Treatment Outcome; Respiratory Function Tests; Observational Studies as Topic
- 摘要:
- 目的 分析先天性膈疝（congenital diaphragmatic hernia，CDH）手术后患儿近期肺功能情况，探索影响肺功能的相关因素，以指导临床随访。方法 以2016年4月至2021年1月首都儿科研究所附属儿童医院新生儿外科收治的CDH患儿为研究对象，患儿均经手术修补治疗，并进行肺功能检查。肺功能检查时间中位数为术后1.6个月（最长18个月，最短11 d），按照肺功能结果分为肺功能正常组、肺功能异常组（包括阻塞性通气功能异常、限制性通气功能异常、混合性通气功能异常）。比较两组临床资料（包括产前诊断时间、肝脏疝入情况、缺损大小、手术时机、用氧时长等）的差异。结果 共32例CDH患儿纳入分析，其中肺功能正常5例（15.6%），肺功能异常27例（84.4%）。以第1次肺功能测定结果为准，阻塞性通气功能异常20例（62.5%），限制性通气功能异常3例（9.4%），混合性通气功能异常4例（12.5%）。肺功能正常组与肺功能异常组手术前肺动脉高压人数比例（2/5比23/27）、用氧时长[（12.22±6.09） d比（21.48±9.12） d]的差异具有统计学意义（P<0.05）；出生后30 d用氧情况（1/5比18/27），差异无统计学意义（P>0.05）。产前诊断时间肺功能异常组的均值明显小于正常组，但差异无统计学意义[（30.67±3.51）周比（26.77±4.38）周，P>0.05]。结论 部分先天性膈疝患儿术后早期存在不同程度的肺功能异常，需予以高度重视。术后早期以阻塞性通气功能异常多见，肺动脉高压、用氧时长以及产前诊断时间可能是患儿肺功能异常的相关因素。
- Abstract:
- Objective To analyze the recent postoperative lung function of children with congenital diaphragmatic hernia (CDH), and explore the risk factors affecting lung function to guide the clinical follow-up.Methods The clinical data of children undergoing CDH repair and lung function examination from April 2016 to January 2021 was retrospectively reviewed.According to the result of lung function exmination, they were divided into normal group and abnormal group (including obstructive ventilation dysfunction, restricted ventilation dysfunction and mixed ventilation dysfunction) and compared the intergroup differences.The mean time of lung function test was 1.6 months (11 days-18 months) after repair.Results Of the 32 cases of CDH children.5 (15.6%) had normal pulmonary functionwhile other 27(84.4%) had adnormal pulmonary function.Subject to the result of the first lung function examination, 20(62.5%) cases showed obstructive ventilation dysfunction, 3(9.4%) cases showed restricted ventilation dysfunction, and 4(12.5%) cases showed mixed ventilation dysfunction.Both normal and abnormal groups had statistical differences in pulmonary artery hypertension(2/5 vs.23/27, P<0.05), oxygen duration[(12.22±6.09) d vs.(21.48±9.12) d, P<0.05].The oxygen use at 30 days after birth had no significant statistical significance.The mean of prenatal diagnosis time of abnormal group was significantly smaller than normal group, but there was no significant statistical difference[(30.67±3.51) w vs.(26.77±4.38) w, P>0.05].Conclusion Attention should be paid to CDH children who have different degrees of lung dysfunction early after surgery.Obstructive ventilation dysfunction is more common after CDH repair.Arterial hypertension and oxygen use duration may be risk factors for lung dysfunction.It is speculated that the prenatal diagnosis time may affect the lung function of children with CDH.
参考文献/References:
[1] de Buys Roessingh AS, Dinh-Xuan AT.Congenital diaphragmatic hernia:current status and review of the literature[J].Eur J Pediatr, 2009, 168(4):393-406.DOI:10.1007/s00431-008-0904-x.
[2] Lee HS, Dickinson JE, Tan JK, et al.Congenital diaphragmatic hernia:Impact of contemporary management strategies on perinatal outcomes[J].Prenat Diagn, 2018, 38(13):1004-1012.DOI:10.1002/pd.5376.
[3] Hollinger LE, Buchmiller TL.Long term follow-up in congenital diaphragmatic hernia[J].Semin Perinatol, 2020, 44(1):151171.DOI:10.1053/j.semperi.2019.07.010.
[4] 张皓, 邬宇芬, 黄剑锋, 等.儿童肺功能检测及评估专家共识[J].临床儿科杂志, 2014, 32(2):104-114.DOI:10.3969/j.issn.1000-3606.2014.02.002.Zhang H, Wu YF, Huang JF, et al.The expert consensus on examination and evaluation of children’s pulmonary function[J].J Clin Ped, 2014, 32(2):104-114.DOI:10.3969/j.issn.1000-3606.2014.02.002.
[5] Donahoe PK, Longoni M, High FA.Polygenic cases of congenital diaphragmatic hernia produce common lung pathologies[J].Am J Pahol, 2016, 186(10):2532-2543.DOI:10.1016/i.ajpath.2016.07.006.
[6] Peetsold MG, Heij HA, Kneepkens CM, et al.The long-term follow-up of patients with a congenital diaphragmatic hernia:a broad spectrum of morbidity[J].Pediatr Surg Int, 2009, 25(1):1-17.DOI:10.1007/s00383-008-2257-y.
[7] Cauley RP, Potanos K, Fullington N, et al.Pulmonary support on day of life 30 is a strong predictor of increased 1 and 5-year morbidity in survivors of congenital diaphragmatic hernia[J].J Pediatr Surg, 2015, 50(5):849-855.DOI:10.1016/j.jpedsurg.2014.12.007.
[8] Wigen RB, Duan WM, Moraes TJ, et al.Predictors of long-term pulmonary morbidity in chidren with congenital diaphragmatic hernia[J].Zeitschift Fur Kinderchirurgi, 2019, 29(1):120- 124.DOI:10.1055/s-0038-1676586.
[9] Rygl M, Rounova P, Sulc J, et al.Abnormalities in pulmonary function in infants with high-risk congenital diaphragmatic hernia[J].Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2015, 159(3):497-502.DOI:10.5507/bp.2015.040.
[10] 王伟鹏, 谢伟, 刘全华, 等.先天性膈疝术后肺功能转归的临床研究[J].中华小儿外科杂志, 2020, 41(1):29-33.DOI:10.3760/cma.j.issn.0253-3006.2020.01.006.Wang WP, Xie W, Liu QH, et al.Pulmonary function in infants with congenital diaphragmatic hernia[J].Chin J Pediatr Surg, 2020, 41(1):29-33.DOI:10.3760/cma.j.issn.0253-3006.2020.01.006.
[11] Wright T, Filbrun A, Bryner B, et al.Predictors of early lung function in patients with congenital diaphragmatic hernia[J].J Pediatr Surg, 2014, 49(6):882-885.DOI:10.1016/j.jpedsurg.2014.01.016
[12] Koumbourlis AC, Wung JT, Stolar CJ.Lung function in infants after repair of congenital diaphragmatic hernia[J].J Pediatr Surg, 2006, 41(10):1716-1721.DOI:10.1016/.jpedsurg.2006.05.044.
[13] Toussaint-Duyster LCC, van der Cammen-van Zijp MHM, Spoel M, et al.Lung function in school-aged congenital diaphragmatic hernia patients; a longitudinal evaluation[J].Pediatric Pulmonology, 2019, 54(8):1257-1266.DOI:10.1002/ppul.24375.
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]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(03):0.
[4].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(03):0.
[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]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.
[12]曾嘉航,李乐,刘威,等.儿童疝针在膈疝修补术中的应用[J].临床小儿外科杂志,2017,16(01):44.
[13]舒仕瑜,张智恩,陈功,等.先天性膈疝患儿手术后近期肺功能的临床观察[J].临床小儿外科杂志,2017,16(05):444.
[14]段贤伦,章鹏,商子寅,等.经胸径路手术治疗小儿膈疝９例[J].临床小儿外科杂志,2017,16(05):510.
[15]李海振,马立霜,王莹,等.新生儿先天性膈疝预后相关因素分析[J].临床小儿外科杂志,2022,21(05):458.[doi:10.3760/cma.j.cn101785-202012069-011]
Li Haizhen,Ma Lishuang,Wang Ying,et al.Analysis of prognostic factors of neonatal congenital diaphragmatic hernia[J].Journal of Clinical Pediatric Surgery,2022,21(03):458.[doi:10.3760/cma.j.cn101785-202012069-011]
[16]侯龙龙,林土连,何秋明,等.先天性膈疝疝囊的产前识别及其对预后的影响[J].临床小儿外科杂志,2022,21(09):827.[doi:10.3760/cma.j.cn101785-202206003-006]
Hou Longlong,Lin Tulian,He Qiuming,et al.Prenatal identification of hernia sac in congenital diaphragmatic hernia and its effect on prognosis[J].Journal of Clinical Pediatric Surgery,2022,21(03):827.[doi:10.3760/cma.j.cn101785-202206003-006]
[17]高琼,黄强,毛翠平,等.胎儿磁共振在先天性膈疝患儿预后评估中的应用研究[J].临床小儿外科杂志,2022,21(09):838.[doi:10.3760/cma.j.cn101785-202206003-008]
Gao Qiong,Huang Qiang,Mao Cuiping,et al.Prognostic values of different parameters acquired from fetal magnetic resonance imaging in congenital diaphragmatic hernia[J].Journal of Clinical Pediatric Surgery,2022,21(03):838.[doi:10.3760/cma.j.cn101785-202206003-008]
[18]刘蕊,郑泽兵,高明娟,等.胸腔镜手术和传统开放手术治疗新生儿先天性膈疝的单中心研究[J].临床小儿外科杂志,2023,22(01):18.[doi:10.3760/cma.j.cn101785-202203079-004]
Liu Rui,Zheng Zebing,Gao Mingjuan,et al.A single center study of thoracoscopic surgery and traditional open surgery for neonatal congenital diaphragmatic hernia[J].Journal of Clinical Pediatric Surgery,2023,22(03):18.[doi:10.3760/cma.j.cn101785-202203079-004]
[19]孟楚怡,冯众,王莹,等.多学科诊疗模式下先天性膈疝患儿的临床转归[J].临床小儿外科杂志,2023,22(08):706.[doi:10.3760/cma.j.cn101785-202304028-002]
Meng Chuyi,Feng Zhong,Wang Ying,et al.Analysis of clinical outcomes for infants with congenital diaphragmatic hernia under a multidisciplinary diagnostic and treatment approach[J].Journal of Clinical Pediatric Surgery,2023,22(03):706.[doi:10.3760/cma.j.cn101785-202304028-002]
备注/Memo
收稿日期:2021-07-16。
基金项目:国家重点研发计划（2018YFC1002503）；北京市卫生与健康科技成果与适宜技术推广项目（BHTPP202005）；北京市儿科学科协同发展中心儿科重点专项（XTZD20180305）
通讯作者:马立霜,Email:malishuang2006@sina.com