摘要
目的探讨新生儿重症先天性膈疝(congenital diaphragmatic hernia,CDH)的手术方式和围手术期处理措施,总结临床经验。方法回顾性分析2012年1月至2017年6月武汉儿童医院收治的48例CDH患儿的临床资料。根据手术方式不同分为开放手术组(n=21)和腔镜手术组(n=27),早期阶段(2014年前)均采取常规开胸手术治疗,共21例;后期(2014年后)主要采取胸腔镜手术治疗,共27例,中转开胸手术6例。对比分析两组患儿年龄、体重、合并畸形、术前治疗、手术经过及术后并发症。结果本组总治愈率为79.17%(38/48)。27例采取胸腔镜手术,其中6例中转开胸手术,2例实施胸腔镜手术后放弃治疗,ICU内死亡2例,治愈率80.95%(17/21);21例采取开胸手术,其中6例死亡,治愈15例,治愈率71.43%(15/21);两组治愈率比较差异无统计学意义(χ2=0.525,P>0.05)。比较胸腔镜手术组和开胸手术组的手术时间、术后呼吸机辅助时间及住院时间,差异均有统计学意义(P<0.05)。术后并发症胸腔镜手术组复张性肺水肿4例、气胸2例;开胸手术组复张性肺水肿6例、气胸1例,差异无统计学意义(P>0.05)。本研究共38例患儿存活,随访6个月至3年,无复发,预后良好。结论新生儿重症膈疝的病死率仍较高,尽早手术、合理机械通气等综合治疗是提高存活率的关键。
Objective To explore the surgical approaches and perioperative managements of congenital diaphragmatic hernia(CDH)in neonates and summarize the relevant clinical experiences.Methods From January 2012 to June 2017,retrospective analysis was performed for the clinical data of 48 hospitalized CDH neonates.According to different surgical approaches,they were divided into two groups of open surgery and endoscopy.Early-stage(prior to 2014)conventional thoracic surgery was performed(n=21);after 2014,thoracoscopy(n=27)and transit thoracotomy(n=6).Two groups were compared with regards to age,weight,concurrent malformations,preoperative therapy,surgical approaches and postoperative complications.Results The overall curative rate was 79.17%(38/48).Thoracoscopy(n=21)and transit thoracotomy(n=6)were performed.The outcomes were discharge after thoracoscopy(n=2)and mortality in intensive care unit(n=2).And the curative rate was 80.95%(17/21).Thoracotomy(n=21)was performed.Six children died postoperatively and the curative rate was 71.43%(15/21).There was no significant inter-group difference(P>0.05).As for operative duration,ventilator-assisted time and hospitalization duration,the differences were statistically significant(P<0.05).Reexpansion pulmonary edema(n=4 vs.6)and pneumothorax(n=2 vs.1)occurred in thoracoscopy and thoracotomy groups respectively.There was no significant inter-group difference(P>0.05).Finally 38 children survived.During a follow-up period of 6-36 months,the prognosis was excellent and no recurrence.Conclusion Neonatal mortality remains high for severe CDH.Early surgery and proper mechanical ventilation are vital for improving its survival rate.
作者
陈义初
皮名安
Chen Yichu;Pi Ming'an(Department of Cardiothoracic Surgery,Wuhan Women&Children Medical Care Center,Wuhan 430016,China)
出处
《临床小儿外科杂志》
CAS
2019年第12期1049-1052,共4页
Journal of Clinical Pediatric Surgery
基金
武汉市卫生健康委员会卫生科研项目(编号:WX14C54)
关键词
疝
横隔/先天性
胸腔镜
外科手术
治疗
方法
对比研究
婴儿
新生
Hernia
Diaphragmatic/CN
Thoracoscopes
Surgical Procedures
Operative
Therapy
Methods
Comparative Study
Infant
Newborn
