疝囊对先天性膈疝患儿临床结局的影响

Effect of hernia sac on outcomes in infants with congenital diaphragmatic hernia

目的探索存在疝囊与先天性膈疝患儿临床预后的相关性。方法收集2001年1月至2017年12月上海交通大学医学院附属新华医院小儿外科收治的160例经手术治疗能够明确有无合并疝囊的先天性膈疝(CDH)患儿的临床资料,复习患儿明确诊断时的孕周、患儿娩出孕周、性别、Apgar评分、出生体重、肝位置、入院时血气分析、伴发畸形、手术方式、有无疝囊、膈肌缺损大小、是否需要补片修补和转归情况等。按有无疝囊,将患儿分为疝囊组和无疝囊组,进行对比分析,并采用SPSS17.0软件进行统计学分析。结果160例CDH患儿中,行经腹开放手术83例,微创手术77例;术中明确有疝囊63例(疝囊组),无疝囊97例(无疝囊组);需补片修补25例(15.6%),术后存活138例(86.3%)。与无疝囊组患儿比较,疝囊组出生体重较大[(3310.0±397.3)g比(3099.8±531.2)g]、1分钟Apgar和5分钟Apgar评分较好[(9.04±0.95)分比(8.61±1.23)分,(9.63±0.60)分比(9.19±0.98)分]、O/ELHR较大[(64.58±12.49)%比(50.63±12.15)%)]、入院血气分析中pH较高(7.30±0.13比7.22±0.14)、PaCO2较低(46.63±13.69比60.53±21.00)、且术中需要补片修补的概率较低(6.3%比21.6%),组间比较,差异均有统计学意义(P均<0.05)。而在性别、膈肌缺损大小分级、手术方式、产前诊断、合并其他畸形等方面,两组间差异无统计学意义。与无疝囊组患儿比较,疝囊组术后呼吸机辅助通气时间较短[(4.3±0.7)d比(7.6±1.0)d]、住院周期较短[(21.7±11.5)d比(28.1±15.8)d]、存活率较高(96.8%比79.4%),组间比较,差异均有统计学意义(P均<0.05)。结论合并疝囊的CDH患儿临床症状较轻,术后恢复快,且治愈率较高。

Objective To explore the relationships between hernia sac and the outcomes in infants with congenital diaphragmatic hernia (CDH). Methods The medical records were retrospectively reviewed for 160 CDH neonates from January 2001 to December 2017.The presence or absence of hernia sac was identified intraoperatively.The clinical data included gestational age at diagnosis and delivery, gender, Apgar score at 1/5 min, birth weight, site of liver, admission arterial blood gas analysis, associated anomalies, operative approach, presence of hernia sac, size of defect, necessity of patch repairing and outcomes.They were divided into two groups of hernia sac and no-sac.Clinical parameters were compared and analyzed with SPSS 17.0 software. Results Among 160 CDH neonates, 83 infants underwent open surgery and another 77 mini-invasive surgery.Sixty-three patients had a hernia sac and another 97 without a hernia sac.Twenty-five (15.6%) patients underwent patch repairing.And 138 infants (86.3%) survived.Compared with those without hernia sac, patients with hernia sac had more favorable outcomes as quantified by significantly higher birth weight [(3 310.0±397.3) vs.(3 099.8±531.2)g], higher Apgar score at 1 & 5 min [(9.04±0.95)vs.(8.61±1.23),(9.63±0.60) vs.(9.19±0.98)], higher O/E LHR, higher pH (7.30±0.13 vs.7.22±0.14), lower PaCO2 (46.63±13.69 vs.60.53±21.00) and lower intraoperative requirement of patch repairing (6.3% vs.21.6%)(all P<0.05). However, no differences existed in gender, size of defect, operative approach or prenatal diagnosis.Compared with those in no-sac group, patients in sac group had a shorter duration of mechanical ventilation [(4.3±0.7) vs.(7.6±1.0) days], a shorter length of hospital stay [(21.7±11.5) vs.(28.1±15.8) days] and a higher survival rate [(96.8% vs.79.4%), all P<0.05]. Conclusions The presence of hernia sac indicates more favorable outcomes for CDH infants.