胸腔镜下膈肌折叠术治疗婴幼儿右侧膈膨升

Thoracoscopic diaphragm plication in the treatment of the right diaphragmatic eventration of infants]

目的总结胸腔镜下膈肌折叠术治疗婴幼儿膈膨升的临床经验及疗效。方法自2009年2月至2011年12月作者收治儿童膈膨升15例。其中男12例，女3例，年龄3个月至3岁（平均年龄9个月），回顾性分析手术方法、手术时间、住院时间、患儿康复及随访情况。结果15例均为右侧膈膨升，均在胸腔镜下顺利完成膈肌折叠术。手术时间1-3．5h（平均约2．5h）。术中出血少，无一例并发症，无中转开胸病例。患儿于术后3～7d出院，平均术后住院时间5．2d，2例术后出现肺部感染。术后随访2个月至2年，疗效满意，胸部正位片显示患儿膈肌分别较术前降低1～3个肋间隙，胸壁创伤小，外观满意。结论胸腔镜下膈肌折叠术适合于婴幼儿膈膨升，具有创伤小，恢复快，胸廓外观影响小的优势。

Objetive To preliminary summarize and discuss the thoracoscopic diaphragm plication in the treatment of diaphragmatic eventration of infants. Methods In 15 pediatric cases of diaphragmatic eventra- tion admitted to Department of Pediatric Surgery, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine from February 2009 to December 2011, 12 were male patients and 3 were female patients, the minimum age was 3 - month-old, the maximum age was 3 yearsold, and the average age was 9 months. To sum up its surgical approach, operative time, hospital stays, recovery situation and follow-up results. Results All the patients suffered the right diaphragmatic eventration and completed the thoracoscopic diaphragm plica- tion successfully. Operative time lasted about 1 to 3.5 hours （ Average 2.5 hours）. Less intraoperative blood transfusion, no intraoperative complications were found. No conversion to thoracotomy. Patients discharged 3 to 7 days after surgery and the average postoperative hospital stay was 5.2 days. 2 patients were found with lung infection after surgery. Patients were followed up 2 months to 2 years, the clinical results were satisfactory. Re- view of the anteroposterior chest film showed that musculus diaphragm was lower than the preoperative 1 to 3 in- tercostal space respectively. Chest wall trauma was small and had satisfactory appearance. Conclusions Tho- racoseopic diaphragm plication is suitable in the treatment of diaphragmatic eventration of infants. This surgical method has the advantage of less trauma, quicker recovery and small influence of thorax appearance.