胸腔镜手术治疗新生儿先天性膈疝47例

Thoracoscopic repair of congenital diaphragmatic hernia in neonates: a report of 47 cases

目的:总结胸腔镜手术治疗新生儿先天性膈疝的围手术期处理经验,以期提高先天性膈疝患儿的治愈率。方法:回顾性分析2012年6月至2017年6月山东大学齐鲁儿童医院收治的47例接受胸腔镜手术治疗先天性膈疝患儿的临床资料。分析先天性膈疝患儿的入院年龄、胎龄、出生体质量、是否有产前诊断、膈疝位置、临床表现、手术时机、手术方式、手术时间、术后机械通气时间等资料。结果:47例患儿中,左侧膈疝42例,右侧膈疝5例,产前检查发现先天性膈疝13例。45例患儿顺利完成胸腔镜手术,手术时间为42~150 min,平均为(63±13)min;术中出血量为1.0~9.0 m L,平均为(3.0±1.7)m L;术后需呼吸机支持天数为2.0~11.0 d,平均为(3.9±1.4)d。2例患儿中转开放手术。47例患儿中,术后死亡2例,放弃治疗3例,其余患儿均治愈出院,治愈率为89.4%(42/47)。结论:胸腔镜手术治疗新生儿膈疝疗效确切,可以作为治疗新生儿膈疝的首选方式。

Objective： To review the application of thoracoscopic repair for treatment of congenital diaphragmatic hernia in neonates, so as to improve the cure rate.Methods： Clinical data of 47 neonates with congenital diaphragmatic hernia receiving thoracoscopic repair from June 2012 to June 2017 were reviewed. The admission age,gestational age,birth weight,timing of diagnosis,hernia location,clinical manifestation,surgical timing,surgical method,operation time,postoperative mechanical ventilation time of patients were analyzed. Results： There were 42 cases of left diaphragmatic hernia and 5 cases of right diaphragmatic hernia. Thirteen cases were diagnosed prenatally.Primary diaphragmatic repair was successfully accomplished under thoracoscope in 45 neonates without perioperative complications,while 2 patients were converted to open surgery. The average operation time was（ 63 ± 13） min（ 42-150 min）,the average blood loss was（ 3. 0 ± 1. 7） m L（ 1. 0-9. 0 m L）,and the average postoperative mechanical ventilation time was（ 3. 9 ± 1. 4） d（ 2. 0-11. 0 d）. Two patients died and the treatment was withdrawn in 3 patients with an overall cure rate of 89. 4%（ 42/47）.Conclusion： Thoracoscopic repair is effective and can be used as first-choice treatment of diaphragmatic hernia in neonates.