腹腔镜治疗婴幼儿胸骨后疝

Laparoscopic-assisted repair of Morgagni hernia in children

目的 探讨先天性胸骨后疝的诊断、临床特点、腹腔镜手术方法及并发症。方法 2008年12月至2018年12月首都医科大学附属北京儿童医院胸外科采用腹腔镜手术治疗24例胸骨后疝患儿,男17例,女7例;年龄8个月至4岁,平均年龄1.87岁;12例伴有其他畸形。所有患儿术前均经胸部X线片、消化道造影获得诊断,均择期行腹腔镜下胸骨后疝修补术。按手术方式的不同,分为悬吊腹腔镜组、单部位腹腔镜组和双孔腹腔镜组,比较悬吊腹腔镜组和单部位腹腔镜组在手术时间、手术出血量和术后住院时间的差异。结果 所有患儿均顺利完成手术,其中悬吊腹腔镜手术治疗8例、双孔腹腔镜1例、单部位腹腔镜手术治疗15例。将悬吊腹腔镜组与单部位腹腔镜组进行统计学比较(由于双孔腹腔镜手术例数少,且为悬吊腹腔镜和单部位腹腔镜手术中间的过渡手术方式,故未纳入比较)悬吊腹腔镜组手术时间为(76.88±29.15)min,单部位腹腔镜组手术时间为(31.47±13.44)min,差异具有统计学意义(P<0.05);悬吊腹腔镜组手术出血量为(2.00±1.31)ml,单部位腹腔镜组手术出血量为1.00 ml,差异具有统计学意义(P<0.05);悬吊腹腔镜组术后住院时间为(8.75±2.12)d,单部位腹腔镜组术后住院时间为(4.80±0.86)d,差异具有统计学意义(P<0.05)。所有患儿均于腹腔镜下全程完成手术,无中转开腹病例。均存在疝囊,疝内容物为肝、小肠、结肠、大网膜、回盲部、阑尾。术后随访2~122个月,随访期间悬吊腹腔镜组有1例术后复发,已于我院再次行腹腔镜手术治愈。结论 腹腔镜手术治疗先天性胸骨后疝安全可行,单部位腹腔镜使伤口更为美观,皮下打结法减少缝合疝孔时的张力,操作简化,值得推广。

Objective To explore the clinical features,laparoscopic repairing and outcomes of children with Morgagni hernia(MH).Methods From 2008 to December 2018,24 MH children at a single pediatric hospital were retrospectively reviewed.Clinical presentations,surgical approaches and outcomes were evaluated.There were 17 boys and 7 girls with a median diagnostic age of 1.87(2/3-4)years.Associated anomalies were present in 12/17.Intraoperative hemorrhage,operative duration and postoperative hospitalization stay were compared between gasless laparoscopic and single-site umbilical laparoscopic groups.Results The procedures were gasless laparoscopy(n=8),two-site umbilical laparoscopic repair(n=1)and single-site umbilical laparoscopic repair(n=15);The mean operative duration was(76.88±29.15)versus(31.47±13.44)min in gasless laparoscopic and single-site umbilical laparoscopic groups.And the difference was statistically significant(P<0.05).The mean intraoperative hemorrhage was(2.00±1.31)versus 1.00 ml and the difference was significant(P<0.05);the mean postoperative hospitalization length was(8.75±2.12)versus(4.80±0.86)days and the difference was statistically significant(P<0.05).All children underwent full-thickness abdominal wall repair and none had a conversion into open surgery.Hernia sacs were not resected.Colon was the most commonly herniated organ.There was one recurrence in gasless laparoscopic group during a follow-up period of 2-122 months.Conclusions Laparoscopic-assisted MH repair is a safe and effective treatment for single-site umbilical and full-thickness abdominal wall repair.This simple mini-invasive procedure is well-tolerated and worthy of a wider popularization.