超声指标联合评估对先天性膈疝预后的预测价值研究

Value of multiple ultrasonic indicators in estimating the outcomes of congenital diaphragmatic hernia

目的探讨超声指标联合评估对于先天性膈疝预后的预测价值,为先天性膈疝的精准诊疗提供科学依据。方法回顾性分析2018年1月至2022年12月首都儿科研究所附属儿童医院新生儿外科采取手术治疗的92例先天性膈疝患儿术前超声声像图,收集患儿膈肌缺损长度(≤4 cm和>4 cm)、肝脏位置(肝脏疝入和肝脏未疝入)及胃泡位置(左侧和右侧)、有无疝囊、肺部超声有无异常以及预后情况,按照预后情况将患儿分为死亡组和存活组,统计分析各项指标与患儿预后之间的关系。结果92例中,存活70例(设为存活组)、死亡22例(设为死亡组),病死率为23.9%(22/92)。存活组与死亡组比较,肝脏疝入[25.7%(18/70)比54.5%(12/22)]、有疝囊[72.9%(51/70)比50.0%(11/22)]及肺部存在超声异常[48.6%(34/70)比81.8%(18/22)]所占比例差异均有统计学意义(P<0.05)。Logistic回归分析结果显示:膈肌缺损长度>4 cm(OR=4.513,95%CI:1.120~18.184)、肝脏疝入(OR=3.636,95%CI:1.171~11.290)、肺部超声异常(OR=3.640,95%CI:1.022~12.963)和无疝囊(OR=3.428,95%CI:1.066~11.025)是先天性膈疝患儿预后差的危险因素。膈肌缺损>4 cm、无疝囊、肝脏疝入和肺部超声异常预测先天性膈疝患儿死亡的一致性较低(Kappa值均<0.6),而四者联合评估的一致性较高,Kappa值达0.788。结论超声指标中,膈肌缺损长度、肝脏位置、疝囊和肺发育情况均可作为先天性膈疝患儿预后的评价指标,但联合以上四项指标可以更准确地判断先天性膈疝患儿预后。

Objective To explore the value of multiple ultrasound indicators in the prognosis evaluation of congenital diaphragmatic hernia and provide scientific rationales for an accurate diagnosis and treatment of congenital diaphragmatic hernia(CDH).Methods From January 2018 to December 2022,preoperative ultrasonic images were retrospectively reviewed for 92 CDH children undergoing neonatal surgery.The relevant indicators included length of diaphragmatic defect(≤4 cm&>4 cm),location of liver(liver hernia&non liver hernia)and gastric vesicles(left/right),hernia sac(yes or no)and whether or not lung ultrasound was abnormal.According to their prognosis,they were divided into two groups of death and survival.And the relationship between each indicator and the prognosis of children(death or survival)was statistically examined.Results Among them,70 survived and 22 died with a case fatality rate of 23.9%.Comparing survival group with death group,the difference in the proportion of herniation into liver[25.7%(18/70)vs.54.5%(12/22)],presence of hernial sacs[survival group:72.9%(51/70),death group:50.0%(11/22)]and presence of ultrasonographic abnormality in lungs[survival group:48.6%(34/70),death group:81.8%(18/22)]were statistically significant(all P<0.05).Multivariate Logistic regression analysis indicated that diaphragmatic defect length>4 cm(OR=4.513,95%CI:1.120-18.184),liver herniation into chest(OR=3.636,95%CI:1.171-11.290),lung ultrasonic abnormalities(OR=3.640,95%CI:1.022-12.963)and an absence of hernia sac(OR=3.428,95%CI:1.066-11.025)were risk factors for a poor prognosis of CDH.Kappa values for diaphragmatic defect length>4 cm,liver herniation into chest,absence of hernia sac and lung ultrasonic abnormalities were<0.6 whereas Kappa value for a combination of these four parameters was 0.788.Conclusions Diaphragmatic defect length,liver location,hernia sac and lung function may be employed as prognostic indicators for CDH children.And a combination of the above four parameters can more accurately predict the outcomes of CDH children.