目的 探讨胸腔镜手术治疗非新生儿期先天性膈疝的手术方法、并发症及临床经验。 方法 2011年5月至2016年9月我们采取胸腔镜手术治疗77例先天性膈疝患儿(共80例次手术),其中男性51例,女性29例; 年龄1个月至8岁,平均年龄1.66岁。左侧55 例,右侧25例。术前均经胸片、上消化道造影或胸部CT获得诊断,均择期行胸腔镜下膈肌修补术。 结果 80例均顺利完成手术,术中探查无疝囊11例,有疝囊69例,膈肌缺损范围 2.5 cm×2 cm至8 cm×5 cm。手术时间30～125 min,平均66 min; 术中出血量1～10 mL,平均1.8 mL。术闭均留置胸腔闭式引流管,术中中转开胸手术1例,术后平均住院时间 8.4 d。77例均获随访,随访时间3个月至5年,随访期间复发3例,均于本院再次手术治愈。 结论 胸腔镜手术治疗非新生儿期先天性膈疝有一定的安全性和可行性。
Objective To explore the efficacies of thoracoscopic surgery for repairing congenital diaphragmatic hernia(CDH)in children and infants and summarize the relevant experiences. Methods A total of 80 children and infants with CDH underwent thoracoscopic surgery between April 2011 and September 2016. Among them, there were 51 boys and 29 girls with an age range of 1 month to 8 years. The involved sides were left(n=55)and right(n=25). All preoperative diagnoses were made by chest radiography, upper gastrointestinal radiography or computed tomography(CT)scan. None of them underwent emergency surgery. Results All 80 cases were operated successfully. Hernia sac existed in 69 cases. The size of diaphragmatic defect ranged from 2.5 cm×2 cm～8 cm×5 cm. The mean operative duration was 66(30～125)min and mean volume of intraoperative blood loss 1.8(1～10)mL. All cases had chest drainage after surgery. During follow-ups, 3 recurrent cases underwent thoracoscopic surgery. Conclusion As a selected surgery, thoracoscopic repair is both safe and feasible for CDH in children and infants.
