小儿迟发型膈疝的临床分析

Clinical analysis of delayed diaphragmatic hernia in children

目的总结迟发型膈疝患儿的临床表现,讨论影响手术期限选择的因素。方法收集2006年1月至2013年6月,西安市儿童医院收治迟发型膈疝患儿47例,对其年龄、症状、体征、辅助检查、合并疾病、术中所见肺发育情况、手术期限等资料进行回顾性分析。结果以呼吸系统症状为主要表现就诊者25例,占53%。以消化系统症状就诊者14例,占30%。平素无症状,体检发现者8例。胸片确诊22例,胸部CT确诊18例。与是否进行急诊手术有关的因素有临床症状、合并疾病情况、术前误诊误治(经Fisher确切概率法统计,P值分别为0.010、0.010、0.011,均P<0.05)。结论迟发型膈疝患儿的临床表现多样,临床上应积极完善相关检查,全面分析病情,早期诊断。

Objective To summarize the clinical manifestations of delayed diaphragmatic hernia in children and to analyze the influencing factors of operation time limit.Methods A retrospective analysis was conducted on the age , symptoms, signs, auxiliary examinations, comorbidities , intraoperative findings of lung development and operation time limit of 47 children with delayed diaphragmatic hernia treated in the period of January 2006 to June 2013 in Xi＇an Children＇s Hospital.Results There were 25 cases with respiratory symptoms as the main manifestation , accounting for 53%, and 14 patients with digestive symptoms as the main manifestation （ 30%） .Eight cases were diagnosed by physical examination but they were asymptomatic when not taking examination .There were 22 cases diagnosed with chest X-ray and 18 cases with chest CT .Clinical symptoms , combined diseases and misdiagnosis before operation were related factors of whether emergency operation was needed （The Fisher exact statistical conclusion：P value was 0.010,0.010 and 0.011, respectively, all P〈0.05）.Conclusion The clinical manifestations of delayed diaphragmatic hernia are various .Related examinations should be taken positively and the patients ＇ condition should be analyzed from all aspects for early diagnosis .