胸腔镜下疝环针带线法治疗新生儿先天性膈疝疗效观察

Therapeutic effect of thoracoscopic hernia ring needle and thread method in treatment of neonatal congenital diaphragmatic hernia

目的:观察胸腔镜下疝环针带线法治疗新生儿先天性膈疝的疗效。方法:筛选接受胸腔镜手术治疗的先天性膈疝新生儿54例为研究对象,按随机数字表法分为研究组(27例,采用胸腔镜下疝环针带线法治疗)和对照组(27例,采用胸腔镜下膈肌修补术治疗)。比较两组患儿临床疗效、围手术期指标(术中出血量、切口长度、手术时间、术后进食时间、术后机械通气时间及住院时间)、血气指标[二氧化碳分压(PaCO_(2))、呼气末CO_(2)分压(ETCO_(2))及气道峰压]、术后并发症、复发及生存情况。结果:研究组临床总有效率高于对照组,但差异无统计学意义(P>0.05)。研究组术中出血量、切口长度、手术时间、术后进食时间、术后机械通气时间及住院时间低于对照组(均P<0.05)。两组术前、气胸后10 min及放气后30 min的ETCO_(2)、PaCO_(2)及气道峰压比较差异无统计学意义(均P>0.05)。气胸后10 min,两组ETCO_(2)、PaCO_(2)及气道峰压均明显高于术前(均P<0.05)。放气后30 min,两组ETCO_(2)、PaCO_(2)及气道峰压明显低于气胸后10 min(均P<0.05),但与术前比较差异无统计学意义(均P>0.05)。两组患儿术后并发症总发生率、复发率及生存率比较差异无统计学意义(均P>0.05)。结论:虽然与胸腔镜下膈肌修补术相比疗效、血气指标、并发症、复发及生存情况相当,但胸腔镜下疝环针带线法术中出血量较少,手术切口较小,手术时间、术后进食时间、术后机械通气时间及住院时间较短,在临床中治疗新生儿先天性膈疝时,若胸腔镜下疝环针带线法技术成熟,可优先选择。

Objective:To observe the therapeutic effect of thoracoscopic hernia ring needle and thread method in treatment of neonatal congenital diaphragmatic hernia.Methods:A total of 54 neonates with congenital diaphragmatic hernia treated by thoracoscopic surgery were selected and divided into study group(27 cases,treated with thoracoscopic hernia ring needle and thread method)and control group(27 cases,treated with thoracoscopic diaphragm repair)according to random number table method.The clinical efficacy,perioperative indexes(intraoperative blood loss,incision length,operation time,postoperative feeding time,postoperative mechanical ventilation time and hospital stay),blood gas indexes(PaCO_(2),ETCO_(2) and peak airway pressure),postoperative complications,recurrence and survival were compared between the two groups.Results:The clinical total effective rate of the study group was higher than that of the control group,but the difference was not statistically significant(P>0.05).The intraoperative blood loss,incision length,operation time,postoperative feeding time,postoperative mechanical ventilation time and hospital stay in the study group were lower than those in the control group(all P<0.05).There was no significant difference in ETCO_(2),PaCO_(2) and airway peak pressure between the two groups before operation,10 minutes after pneumothorax and 30 minutes after deflation(all P>0.05).At 10 minutes after pneumothorax,ETCO_(2),PaCO_(2) and peak airway pressure in both groups were significantly higher than those before operation(all P<0.05).At 30 minutes after deflation,ETCO_(2),PaCO_(2) and peak airway pressure in the two groups were significantly lower than those at 10 minutes after pneumothorax(all P<0.05),but there was no significant difference in comparison with preoperative(all P>0.05).There was no significant difference in the overall incidence of postoperative complications,recurrence rate and survival rate between the two groups(all P>0.05).Conclusion:Although the efficacy,blood gas indexes,complications,recurrence and survival are comparable to those of thoracoscopic diaphragmatic repair,but the intraoperative blood loss,incision length,operation time,postoperative feeding time,postoperative mechanical ventilation time and hospital stay are shorter in thoracoscopic hernia ring needle and thread method.In the clinical treatment of neonatal congenital diaphragmatic hernia,if the technique of thoracoscopic hernia ring needle and thread method is mature,it can be preferred.