先天性膈疝的临床特点及外科治疗经验

CLINICAL PRESENTATIONS AND EXPERIENCE OF SURGICAL TREATMENT IN CONGENITAL DIAPHRAGMATIC HERNIA

为提高新生儿先天性膈疝(CDH)的早期诊断、治疗及预后水平,对28例先天性膈疝病例进行临床特征、手术过程回顾性分析。全部进行正位及侧位胸部X-线检查,5例做上消化道造影,13例做血气分析。X-线证实胸腔内有含水的肠管,腹腔没有气体,部分患儿有胃食管返流(GER)、存在吸入性肺炎或脑发育不全;血气分析显示部分婴儿严重的缺氧、呼吸性酸中毒;消化道造影显示结肠或小肠在胸腔内。结果:2例新生儿放弃治疗,26例患儿手术治疗,3例死亡,23例病人恢复良好。结论:对患有先天性膈疝的新生儿必须早期诊断和手术治疗。

In order to better understanding and early diagnosis and management of congenital diaphragmatic hernia( CDH) in the newborn, The clinical manifestations, operative progress of 28 cases were reviewed retrospectively. Diagnosis can be confirmed by the anterio-posterior and lateral chest X-ray with the upper gastrointestinal contrast and Blood gas. X-ray demonstrated an air filled viscera in the anterior mediasti- num, no-air in the abdominal cavity. Some newborns with gestro-esophageal reflux(GER) , and aspiration pneumonia or atelectasis. The Infant may have severe hypoxia and respiratory acidosis, Gastroinestinal-graphy showed, the colon or small intestine in the chest. Two newborns give up treatment, and 26 patients were operated. Three patients died of electrolytic disturbance or obstruaction of intestine. Other cases recovered well after operation. Conclusion: In order to improve the prognosis of CDH, the neonates and infants with CHD must be early diagnosed and treated.