婴幼儿先天性膈疝的诊断和外科治疗

The diagnosis and surgical treatment of congential diaphragmatic hernia in infants

目的 探讨婴幼儿先天性膈疝的诊断方法和外科治疗效果。方法 回顾性分析近 10年来收治的 18例婴幼儿先天性膈疝病例 ,通过X线吞钡动态透视确诊。食管狭窄采用纵切横缝治疗 ,并将膈肌切口折叠交叉缝合于食管前后 ,做成人工膈肌角。另采用Belsey方法行His角成形 ,防止术后食物反流。结果 本组无死亡病例 ,均痊愈出院。术后随访 1～ 5年无其他并发症。结论 动态下行X线钡餐透 ,视对诊断婴幼儿先天性膈疝有决定性帮助。手术是治疗食管狭窄及膈疝所引起呕吐的唯一方法。

Objective: To review the experience in diagnosis and surgical treatment of congenital diaphragmatic hernia. Methods: Retrospective study was carried out on 18 infants with congenital diaphragmatic hernia admitted oved the last 10 years. The diagnosis of this condition was confirmed by barium swallowing fluoroscopy. The esophageal stenosis was treated by longitudinal incision and transverse single layer suture. The edges of the diaphragm incision were crossly folded and sutured. Crusing diaphragm was reconstructed. Belsey's procedure was performed to prevent postoperative gastroe sophageal reflux. Results: There was no postoperative death. All eighteen patients survived 1-5 years after operation without any complications. Conclusion: In congenital short esophagus complicated with diaphragmatic hernia barium meal is a helpful method for diagnosis. Surgery is the only method to relieve symptomes. Esophgeal hiatus and His angle plasty play an important role in proventing postoperative gastroesophageal reflux.