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(01):18-22.[doi:10.3760/cma.j.cn101785-202203079-004]
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
- Title:
- A single center study of thoracoscopic surgery and traditional open surgery for neonatal congenital diaphragmatic hernia
- Keywords:
- Thoracoscopes; Hernias; Diaphragmatic; Congenital; Infant; Newborn; Surgical Procedures; Operative
- 摘要:
- 目的 比较胸腔镜手术和传统开放手术治疗先天性膈疝(congenital diaphragmatic hernia,CDH)的临床疗效、安全性和有效性。方法 回顾性分析遵义医科大学附属医院2013年6月至2020年6月收治的37例CDH患儿临床资料,根据手术方式分为腔镜手术组和开放手术组。其中腔镜手术组24例,采用胸腔镜手术治疗CDH;开放手术组13例,采用传统开放手术治疗CDH。两组患儿一般资料和膈疝特征比较,差异无统计学意义(P>0.05)。主要观察指标包括复发率、住院天数、手术时长、术后机械通气时间、术后开奶时间、达到目标喂养时间;次要观察指标包括手术切口感染情况、术中出血量、膈疝口径大小。结果 腔镜手术组与开放手术组患儿住院天数[(13.46±2.41)d比(18.77±2.89)d]、术后机械通气时间[(3.81±0.80)d比(5.98±1.06)d]、术后开奶时间[(4.35±1.03)d比(7.46±1.45)d]、达到目标喂养时间[(8.33±1.74)d比(13.38±2.22)d]比较,差异均有统计学意义(P＜0.001);两组复发率(1/24比1/13)差异无统计学意义(P=1.000);开放手术组死亡1例,腔镜手术组无一例死亡,差异无统计学意义(P>0.05)。结论 腔镜下CDH修补术具有手术时间短、创伤小、切口美观、术后恢复快、复发率低等优点,是一种安全、有效的手术方式,有望成为治疗CDH的首选术式。
- Abstract:
- ObjectiveTo compare the clinical efficacy,safety and efficacy of thoracoscopy versus traditional open surgery for congenital diaphragmatic hernia (CDH).MethodsFrom June 2013 to June 2020,a total of 37 CDH children with admitted were selected as research objects and divided into two groups of endoscopic (n=24) and open (n=13) according to surgical approaches.Major outcomes included recurrence rate,length of hospital stay,operation duration,postoperative mechanical ventilation time,postoperative lactation time and target feeding time.Secondary outcomes included incision infection,intraoperative blood loss and hernia diameter.ResultsGeneral profiles and hernia characteristics were similar in two groups.Length of hospital stay[(13.46±2.41) vs.(18.77±2.89) days],postoperative mechanical ventilation time[(3.81±0.80) vs.(5.98±1.06) days],postoperative open milking time[(4.35±1.03) vs.(7.46±1.45) days]and time to reach target feeding[(8.33±1.74) vs.(13.38±2.22) days].The differences were statistically significant (P<0.001);Recurrence rate[(4.2%,1/24) vs.(7.7%,1/13) days]was not statistically significant (P=1.000);One child died in open group and there was no mortality in thoracoscopic group.ConclusionThoracoscopic CDH repair offers the advantages of shorter operative duration,minimal trauma,cosmetic incision,faster postoperative recovery and lower recurrence rate.It is a safe and effective surgical option for CDH.
参考文献/References:
[1] Burgos CM,Frenckner B,Luco M,et al.Prenatally versus postnatally diagnosed congenital diaphragmatic hernia-side,stage,and outcome[J].J Pediatr Surg,2019,54(4):651-655.DOI:10.1016/j.jpedsurg.2018.04.008.
[2] Peetsold MG,Heij HA,Kneepkens CMF,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.
[3] Blumenfeld YJ,Belfort MA.New approaches to congenital diaphragmatic hernia[J].Curr Opin Obstet Gynecol,2020,32(2):121-127.DOI:10.1097/GCO.0000000000000615.
[4] Leeuwen L,Fitzgerald DA.Congenital diaphragmatic hernia[J].J Paediatr Child Health,2014,50(9):667-673.DOI:10.1111/jpc.12508.
[5] Ma LS,Wei YD,Liu SL,et al.A comparison of clinical outcomes between endoscopic and open surgery to repair neonatal diaphragmatic hernia[J].J Minim Access Surg,2017,13(3):182-187.DOI:10.4103/jmas.JMAS_208_16.
[6] 魏延栋,马立霜,王莹,等.胸腔镜手术治疗先天性膈疝的经验及技术要点分析[J].临床小儿外科杂志,2021,20(9):819-824.DOI:10.12260/lcxewkzz.2021.09.004. Wei YD,Ma LS,Wang Y,et al.Key technical essentials and experiences during thoracoscopy for congenital diaphragmatic hernia[J].J Clin Ped Sur,2021,20(9):819-824.DOI:10.12260/lcxewkzz.2021.09.004.
[7] Barroso C,Correia-Pinto J.Perioperative complications of congenital diaphragmatic hernia repair[J].Eur J Pediatr Surg,2018,28(2):141-147.DOI:10.1055/s-0038-1632374.
[8] Okawada M,Ohfuji S,Yamoto M,et al.Thoracoscopic repair of congenital diaphragmatic hernia in neonates:findings of a multicenter study in Japan[J].Surg Today,2021,51(10):1694-1702.DOI:10.1007/s00595-021-02278-6.
[9] Szavay PO,Obermayr F,Maas C,et al.Perioperative outcome of patients with congenital diaphragmatic hernia undergoing open versus minimally invasive surgery[J].J Laparoendosc Adv Surg Tech A,2012,22(3):285-289.DOI:10.1089/lap.2011.0356.
[10] Kiblawi R,Zoeller C,Zanini A,et al.Video-assisted thoracoscopic or conventional thoracic surgery in infants and children:current evidence[J].Eur J Pediatr Surg,2021,31(1):54-64.DOI:10.1055/s-0040-1716878.
[11] Qin J,Ren YY,Ma DL.A comparative study of thoracoscopic and open surgery of congenital diaphragmatic hernia in neonates[J].J Cardiothorac Surg,2019,14(1):118.DOI:10.1186/s13019-019-0938-3.
[12] Schukfeh N,Kuebler JF,Dingemann J,et al.Thirty years of minimally invasive surgery in children:analysis of meta-analyses[J].Eur J Pediatr Surg,2020,30(5):420-428.DOI:10.1055/s-0039-1687901.
[13] Neunhoeffer F,Warmann SW,Hofbeck M,et al.Elevated intrathoracic CO2 pressure during thoracoscopic surgery decreases regional cerebral oxygen saturation in neonates and infants-a pilot study[J].Paediatr Anaesth,2017,27(7):752-759.DOI:10.1111/pan.13161.
[14] Miranda A,Roque S,Serre-Miranda C,et al.Inflammatory response and long-term behavioral assessment after neonatal CO2-pneumothorax:study in a rodent model[J].J Pediatr Surg,2018,53(7):1318-1325.DOI:10.1016/j.jpedsurg.2017.08.016.
[15] Sidler M,Wong ZH,Eaton S,et al.Insufflation in minimally invasive surgery:is there any advantage in staying low?[J].J Pediatr Surg,2020,55(7):1356-1362.DOI:10.1016/j.jpedsurg.2019.11.026.
[16] Tsao K,Lally PA,Lally KP,et al.Minimally invasive repair of congenital diaphragmatic hernia[J].J Pediatr Surg,2011,46(6):1158-1164.DOI:10.1016/j.jpedsurg.2011.03.050.
[17] Rideout DA,Wulkan M.Thoracoscopic neonatal congenital diaphragmatic hernia repair:how we do it[J].J Laparoendosc Adv Surg Tech A,2021,31(10):1168-1174.DOI:10.1089/lap.2021.0420.
[18] Tyson AF,Sola R Jr,Arnold MR,et al.Thoracoscopic versus open congenital diaphragmatic hernia repair:single tertiary center review[J].J Laparoendosc Adv Surg Tech A,2017,27(11):1209-1216.DOI:10.1089/lap.2017.0298.
[19] Bawazir OA,Bawazir A.Congenital diaphragmatic hernia in neonates:open versus thoracoscopic repair[J].Afr J Paediatr Surg,2021,18(1):18-23.DOI:10.4103/ajps.AJPS_76_20.
[20] 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. (收稿日期:2022-03-25)本文引用格式: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(1):18-22.DOI:10.3760/cma.j.cn101785-202203079-004. Citing this article as:Liu R,Zheng ZB,Gao MJ,et al.A single center study of thoracoscopic surgery and traditional open surgery for neonatal congenital diaphragmatic hernia[J].J Clin Ped Sur,2023,22(1):18-22.DOI:10.3760/cma.j.cn101785-202203079-004.
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(01):0.
[4]阳广贤高纪平刘平波曾德斌.NUSS手术矫治先天性漏斗胸102例[J].临床小儿外科杂志,2010,9(03):0.
YANG Guang-xian,GAO Ji-ping,LIU Ping-bo,et al.NUSS procedure for pectus excavatum repair in 102 patients.[J].Journal of Clinical Pediatric Surgery,2010,9(01):0.
[5].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(01):0.
[6]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.
[7]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.
[8]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.
[9]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.
[10]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.
[11]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.[doi:10.3969/j.issn.1671-6353.2019.12.012]
Chen Yichu,Pi Mingan.Surgical treatment of neonatal diaphragmatic hernia[J].Journal of Clinical Pediatric Surgery,2019,18(01):1049.[doi:10.3969/j.issn.1671-6353.2019.12.012]
[12]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(01):153.[doi:10.12260/lcxewkzz.2021.02.009]
备注/Memo
收稿日期:2022-03-25。
基金项目:国家自然科学基金(81760099)
通讯作者:金祝,Email:915884700@qq.com