全胸腔镜手术治疗婴幼儿先天性膈疝的临床研究

doi:10.3760/cma.j.cn101202-20210505-00123

摘要
图/表
参考文献(26)
相关文章 (15)

全文: PDF (4584 KB) HTML (2 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨全胸腔镜手术治疗婴幼儿先天性膈疝的临床效果以及安全性、可行性。方法回顾性研究。纳入2015年4月—2021年3月南京医科大学附属儿童医院小儿心胸外科97例先天性膈疝患儿的临床资料。其中男61例、女36例,年龄2 d~3岁[（3.1 ± 7.2）个月];左侧51例,右侧46例。所有患儿均在胸腔镜下行膈疝修补术,术中观察疝内容物有无坏死、穿孔、损伤等情况,记录胸腔镜手术患儿的手术时间、术中出血量、术后胸腔引流量、引流管拔除时间、手术后住院时间。术后定期随访,观察切口感染、膈膨升、乳糜胸、气胸、肠梗阻等相关并发症发生情况,以及术后膈疝复发情况。结果 97例患儿均在全胸腔镜下顺利完成手术,无一例中转开胸手术。术中见疝囊内容物多为脾脏、胃、大网膜、结肠、小肠等,无肠穿孔坏死、肝脾出血等情况发生。手术时间75~150（90.5 ± 12.1） min,手术出血量6~15（8.3 ± 0.6） mL,术后胸腔引流量30~130（41.2 ± 7.6） mL,引流管拔除时间3~10（6.1 ± 1.3） d,手术后住院时间10~18（11.7 ± 2.1） d。住院期间因缝线脱落导致复发2例,再次行胸腔镜手术治愈;1例患儿术后第1天因左肺严重发育不良死亡。术后96例患儿均获随访,随访时间1个月~3年,平均9.2个月。随访期间无切口感染、乳糜胸、呼吸道感染、肠梗阻、肠穿孔等并发症发生,患儿生长发育良好,无一例复发。结论全胸腔镜手术治疗婴幼儿先天性膈疝具有手术视野暴露清楚、术中出血量少、术后并发症少、住院时间短等优点,短期疗效可靠,安全可行。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	庄著伦
	莫绪明
	孙剑
	戚继荣
	彭卫武
	开宏
	郁迪
	杨玉忠
	丁培成

关键词 ：疝,横膈, 胸腔镜, 婴幼儿

Abstract：Objective To explore the safety, feasibility, and clinical effects of thoracoscopic surgery for congenital diaphragmatic hernia and to summarize the surgical experience. Methods The clinical data of 97 child patients with congenital diaphragmatic hernia obtained from the Department of Pediatric Cardiothoracic Surgery of the Children's Hospital of Nanjing Medical University from April 2015 to March 2021 were retrospectively analyzed. The patients, aged 2 days to 3 years ([3.1 ± 7.2] months), consisted of 61 males and 36 females, and 51 cases were left side, and 46 cases were right side. All children underwent diaphragmatic hernia repair under thoracoscopy. During the operation, the contents of the hernia were observed for necrosis, perforation, and injury, and the time of operation, intraoperative blood loss, postoperative thoracic drainage, drainage tube removal time, and hospital stay time after surgery were recorded. Regular follow-up after operation was performed, and the occurrence of related complications, such as incision infection, diaphragm expansion, chylothorax, pneumothorax, intestinal obstruction, and diaphragmatic hernia recurrence after operation were recorded. Results Thoracoscopic surgery was successfully performed in all patients, and none of them switched to traditional surgery. During the operation, the contents of the hernia sac were mostly spleen, stomach, omentum majus, colon, and small intestine, and intestinal perforation, necrosis, liver, and spleen hemorrhage did not occur. The operation time was 75–150 (90.5 ± 12.1) min, the surgical blood loss was 6–15 (8.3 ± 0.6) mL, postoperative thoracic drainage volume was 30–130 (41.2 ± 7.6) mL, drainage tube removal time was 3–10 (6.1 ± 1.3) d, hospital stay after surgery was 10–18 (11.7 ± 2.1) d. During hospitalization, two cases recurred because of the loss of sutures and thus subjected to thoracoscopic surgery again. One case died of severe dysplasia of the left lung on the first postoperative day. A total of 96 child patients were followed up after the operation. The follow-up time ranged from 1 month to 3 years, with an average of 9.2 months. During the follow-up period, no incision infection, chylothorax, respiratory tract infection, intestinal obstruction, and intestinal perforation were observed. The children grew well and did not suffer a recurrence. Conclusions Total thoracoscopic surgery for the treatment of congenital diaphragmatic hernia in infants has the following advantages: clear surgical field of vision, decreased blood loss during operation, decreased postoperative complications, and short hospital stay. The short-term curative effect is reliable, safe, and feasible.

Key words： Hernia, diaphragmatic Thoracoscopy Infant

收稿日期: 2021-05-05

基金资助:国家自然科学基金（81970265）

通讯作者: 莫绪明, Email： mohsuming15@sina.com

引用本文:

庄著伦, 莫绪明, 孙剑, 戚继荣, 彭卫武, 开宏, 郁迪, 杨玉忠, 丁培成. 全胸腔镜手术治疗婴幼儿先天性膈疝的临床研究[J]. 中华解剖与临床杂志, 2022, 27(1): 19-24.
Zhuang Zhulun, Mo Xuming, Sun Jian, Qi Jirong, Peng Wei, Wu Kaihong, Yu Di, Yang Yuzhong, Ding Peicheng. Clinical study on the complete thoracoscopy of congenital diaphragmatic in infants. Chinese Journal of Anatomy and Clinics, 2022, 27(1): 19-24.

链接本文:

http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20210505-00123 或 http://www.cjac.com.cn/CN/Y2022/V27/I1/19

[1]	Badillo A, Gingalewski C.Congenital diaphragmatic hernia: treatment and outcomes[J]. Semin Perinatol, 2014,38(2):92-96. DOI: 10.1053/j.semperi.2013.11.005.
[2]	张军,李龙,刘钢,等.腹腔镜治疗新生儿膈疝的探讨[J].中华小儿外科杂志,2007,28(3):127-129. DOI:10.3760/cma.j.issn.0253-3006.2007.03.005.
	Zhang J,Li L,Liu G,et al,Laparoscopic repair of congenital diaphragmatic hernia in neonates[J]. Chin J Pediatr Surg,2007, 28(3):127-129. DOI:10.3760/cma.j.issn.0253-3006. 2007.03.005.
[3]	马立霜,李景娜,于斯淼,等.胸腔镜手术治疗新生儿先天性膈疝[J].中华小儿外科杂志,2020,41(1):23-28. DOI: 10.3760/cma.j.issn.0253-3006.2020.01.005.
	Ma LS, Li JN, Yu SM, et al.Neonatal thoracoscopic repair of congenital diaphragmatic hernias[J]. Chin J Pediatr Surg,2020, 41(1): 23-28. DOI: 10.3760/cma.j.issn.0253-3006. 2020.01.005.
[4]	张永婷,李索林.先天性膈疝产前诊断及腔镜矫治研究进展[J].临床小儿外科杂志, 2016,15(1):91-93,101. DOI:10. 3969/j.issn.1671-6353.2016.01.027.
	Zhang YT,Li SL.Prenatal diagnosis and endoscopic therapeutic advance of congenital diaphragmatic hernia[J].Chlin Ped surg,2016,15(1):91-93,101. DOI:10.3969/j.issn.1671-6353.2016.01.027.
[5]	Wagner R, Mayer S, Feng X, et al.Thoracoscopic repair of congenital diaphragmatic hernia[J]. Eur J Pediatr Surg, 2020,30(2):137-141. DOI: 10.1055/s-0040-1702222.
[6]	马丽霜, 李龙. 腔镜手术与开放手术治疗新生儿膈疝的对比研究[J].中华小儿外科杂志, 2014, 35(8):599-602. DOI: 10. 3760/cma.j.issn.0253-3006.2014.08.010.
	Ma LS, Li L.A comparison of clinical outcome of neonatal diaphragmatic hernia between minimally invasive surgery and open repair[J]. Chin J PediatrSurg, 2014,35(8):599-602. DOI: 10.3760/cma.j.issn.0253-3006.2014.08.010.
[7]	Silen ML, Canvasser DA, Kurkchubasche AG, et al.Video-assisted thoracic surgical repair of a foramen of Bochdalek hernia[J]. Ann Thorac Surg, 1995,60(2):448-450. DOI: 10.1016/0003-4975(95)00100-y.
[8]	Becmeur F, Jamali RR, Moog R, et al.Thoracoscopic treatment for delayed presentation of congenital diaphragmatic hernia in the infant. A report of three cases[J]. Surg Endosc, 2001,15(10):1163-1166. DOI: 10.1007/s004640090064.
[9]	Liem NT.Thoracoscopic surgery for congenital diaphragmatic hernia: a report of nine cases[J]. Asian J Surg, 2003,26(4):210-212. DOI: 10.1016/S1015-9584(09)60305-5.
[10]	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.
[11]	Nagata K, Usui N, Terui K, et al.Risk factors for the recurrence of the congenital diaphragmatic hernia-report from the long-term follow-up study of Japanese CDH study group[J]. Eur J Pediatr Surg, 2015, 25(1):9-14. DOI: 10.1055/s-0034-1395486.
[12]	Al-Iede MM, Karpelowsky J, Fitzgerald DA.Recurrent diaphragmatic hernia: modifiable and non-modifiable risk factors[J]. Pediatr Pulmonol, 2016,51(4):394-401. DOI: 10.1002/ppul.23305.
[13]	Kamran A, Zendejas B, Demehri FR, et al.Risk factors for recurrence after thoracoscopic repair of congenital diaphragmatic hernia (CDH)[J]. J Pediatr Surg, 2018,53(11):2087-2091. DOI: 10.1016/j.jpedsurg.2018.04.007.
[14]	Gander JW, Fisher JC, Gross ER, et al.Early recurrence of congenital diaphragmatic hernia is higher after thoracoscopic than open repair: a single institutional study[J]. J Pediatr Surg, 2011,46(7):1303-1308. DOI: 10.1016/j.jpedsurg. 2010.11.048.
[15]	Bogusz B, Mol A, Zgraj O, et al.The application of the percutaneous suturing technique in thoracoscopic repair of congenital diaphragmatic hernia[J]. Adv Clin Exp Med, 2020,29(8):967-970. DOI: 10.17219/acem/122396.
[16]	Putnam LR, Gupta V, Tsao K, et al.Factors associated with early recurrence after congenital diaphragmatic hernia repair[J]. J Pediatr Surg, 2017,52(6):928-932. DOI: 10.1016/j.jpedsurg.2017.03.011.
[17]	Tsai J, Sulkowski J, Adzick NS, et al.Patch repair for congenital diaphragmatic hernia: is it really a problem?[J]. J Pediatr Surg, 2012,47(4):637-641. DOI: 10.1016/j.jpedsurg.2011.11.054.
[18]	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(2):153-160. DOI: 10. 12260/Icxewkzz. 2021. 02. 009.
	Zhao P, Liu X, et al.Zuo W.Analysis of influencing factors for recurrence after thoracoscopic repair of congenital diaphragmac hernia in neonates and its treatment effect on recurrence[J]. Chlin Ped surg, 2021,20(2):153-160. DOI: 10. 12260/Icxewkzz. 2021. 02. 009.
[19]	Yang EY, Allmendinger N, Johnson SM, et al.Neonatal thoracoscopic repair of congenital diaphragmatic hernia: selection criteria for successful outcome[J]. J Pediatr Surg, 2005,40(9):1369-1375. DOI: 10.1016/j.‍jpedsurg.‍2005.05.036.
[20]	Mortellaro VE, Fike FB, Adibe OO, et al.The use of high-frequency oscillating ventilation to facilitate stability during neonatal thoracoscopic operations[J]. J Laparoendosc Adv Surg Tech A, 2011,21(9):877-879. DOI: 10.1089/lap.2011.0134.
[21]	Pierro A.Hypercapnia and acidosis during the thoracoscopic repair of oesophageal atresia and congenital diaphragmatic hernia[J]. J Pediatr Surg, 2015,50(2):247-249. DOI: 10.1016/j.jpedsurg.2014.11.006.
[22]	Gomes Ferreira C, Reinberg O, Becmeur F, et al.Neonatal minimally invasive surgery for congenital diaphragmatic hernias: a multicenter study using thoracoscopy or laparoscopy[J]. Surg Endosc, 2009,23(7):1650-1659. DOI: 10.1007/s00464-009-0334-5.
[23]	Gourlay DM, Cassidy LD, Sato TT, et al.Beyond feasibility: a comparison of newborns undergoing thoracoscopic and open repair of congenital diaphragmatic hernias[J]. J Pediatr Surg, 2009,44(9):1702-1707. DOI: 10.1016/j.jpedsurg.2008.11.030.
[24]	Cho SD, Krishnaswami S, Mckee JC, et al.Analysis of 29 consecutive thoracoscopic repairs of congenital diaphragmatic hernia in neonates compared to historical controls[J]. J Pediatr Surg, 2009,44(1):80-86. DOI: 10. 1016/j.jpedsurg.2008.10.013.
[25]	Kim AC, Bryner BS, Akay B, et al.Thoracoscopic repair of congenital diaphragmatic hernia in neonates: lessons learned[J]. J Laparoendosc Adv Surg Tech A, 2009,19(4):575-580. DOI: 10.1089/lap.2009.0129.
[26]	Okazaki T, Nishimura K, Takahashi T, et al.Indications for thoracoscopic repair of congenital diaphragmatic hernia in neonates[J]. Pediatr Surg Int, 2011,27(1):35-38. DOI: 10.1007/s00383-010-2724-0.