Ultrasound diagnosis of congenital Morgagni hernias: Ten years of experience at two Chinese centers

BACKGROUND Morgagni hernias are rare anomalies that are easily misdiagnosed or missed.AIM To summarize the ultrasound(US)imaging characteristics of Morgagni hernias through a comparison of imaging and surgical results.METHODS The records of children with Morgagni hernias who were hospitalized at two hospitals between January 2013 and November 2023 were retrospectively re-viewed in terms of clinical findings,US features,and operative details.RESULTS Between 2013 and 2023,we observed nine(five male and four female)children with Morgagni hernias.Upper abdominal scanning revealed a widening of the prehepatic space,with an abnormal channel extending from the xiphoid process to the right or left side of the thoracic cavity.The channel had intestinal duct and intestinal gas echoes.Hernia contents were found in the transverse colon(n=6),the colon and small intestine(n=2),and the colon and stomach(n=1).Among the patients,seven had a right-sided lesion,two had a left-sided lesion,and all of them had hernial sacs.CONCLUSION US imaging can accurately determine the location,extent,and content of Morgagni hernias.For suspected Mor-gagni hernias,we recommend performing sonographic screening first.

Neurodevelopmental outcome in congenital diaphragmatic hernia: Evaluation, predictors and outcome

To review the reported neurodevelopmental outcome of congenital diaphragmatic hernia(CDH) survivors, identify important predictors of developmental disabilities, and describe the pathophysiological mechanisms contributing to adverse outcome. A Medline search was performed for English-language articles cross-referencing CDH with pertinent search terms. Retrospective, prospective, and longitudinal follow-up studies were examined. The reference lists of identified articles were also searched. Neurodevelopmental dysfunction has been recognized as one of most common and potentially most disabling outcome of CDH. Intelligence appears to be in the low normal to mildly delayed range. Neuromotor dysfunction is common during early childhood. Behavioral problems, hearing impairment, and quality of life related issues are frequently encountered in older children and adolescence. Disease severity correlates with the degree of neurological dysfunction. Neurodevelopmental follow-up in CDH children should become standard of care to identify those who would benefit from early intervention services and improve neurological outcomes.

Chylothorax after Repair of Congenital Diaphragmatic Hernia in a Neonate: Usefulness of Conservative Management

Aim: Chylothorax is a recognized complication after surgery for congenital diaphragmatic hernia (CDH) in a neonate. Management strategies for chylothorax include cessation of enteral feedings, repeated aspiration, chest drainage, and total parenteral nutrition. It is important to determine which is the better plan for treatment of chylothorax after repair of CDH. The authors report successful management by use of the MCT diet for a neonate with chylothorax after repair of CDH. Case: A male infant weighing 3.0 kg was delivered by cesarean section at 38 weeks of gestation and intubated immediately after birth. Prenatal ultrasonography had disclosed left-sided posterolateral diaphragmatic hernia. After stabilization, surgery was performed via a left-sided transverse supra-abdominal incision. The unfixed colon, small bowel, stomach, and spleen were reduced from the chest with little difficulty. A hernia sac was not present and the left-sided posterolateral diaphragm showed a defect 3.5 cm × 2.0 cm in width. The child was fed via a nasogastric tube starting on postoperative day 4 and dyspnea disappeared. Plain chest X-ray on postoperative day 7 showed left pleural radioopacity. A specimen of the chest drainage examined on postoperative day 10 was typical of lymph, with a triglyceride level of 328 mg/dl. The chest drainage was dark yellowish, and a medium-chain triglyceride formula was used until postoperative day 30, by which time the effusion has disappeared. Discussion: Chylothorax after repair of CDH may be a transient disorder that will resolve after a period of diminished flow through the thoracic lymphatics.

Congenital Diaphragmatic Hernia: A Benin Teaching Hospital Experience

Congenital diaphragmatic hernia is the outcome of the abdominal contents in the thorax by a breach caused by a failure to close the pleuroperitoneal canal. It is a rare and serious disease. Our teaching hospital had registered these seven last years five cases of congenital diaphragmatic hernia, operated, but never published. We report the most recent one, a case of a newborn baby seen at the 5th hour of life for respiratory distress. Initial examination revealed: an asymmetric thorax, respiratory distress with 88% oxygen saturation at ambient air, tachycardia and abolition of vesicular murmur in the left lung field. L-abdomen was flat and soft. Thoraco-abdominal radiography revealed a clear left intra-thoracic image with mass effect on the left lung parenchyma. He has benefited from a reduction of the herniated visceras and a successful closing of the breach. The operation had few after-effects after five months follow-up with a very good recovery of the cardio-pulmonary function.

Early diagnosis and management of Congenital diaphragmatic hernia

This case report describes the case of a full term girl baby with left congenital diaphragmatic hernia(CDH)born to a 36-year-old mother at 38 weeks of gestation.The baby at birth had an APGAR 8 and birth weight 2.930 kgs.Pre operatively,the baby was ventilated and was kept Nil per oral and continued with Total parenteral nutrition.Nasogastric tube continuous suction was done.The parents were counselled for the surgical repair of CDH.On the third day of life,exploratory laparotomy was performed.5 cm diaphragmatic defect was found.The stomach,pancreas,small bowel,large bowel,and spleen were successfully restored from the left thoracic cavity and the diaphragmatic defect was closed.Post operatively,the baby was breastfed well,thermo regulated,maintained saturation,passed urine and stool and was discharged.

Antenatal use of bosentan and/or sildenafil attenuates pulmonary features in rats with congenital diaphragmatic hernia

Background:Lung hypoplasia,pulmonary persistent hypertension of the newborn and its morphological changes are the main features in congenital diaphragmatic hernia(CDH).This study was undertaken to investigate if antenatal use of sildenafil and/or bosentan attenuates vascular remodeling,promotes branching,and improves alveolarization in experimental nitrofeninduced CDH.Methods:Nitrofen(100 mg)was gavage-fed to pregnant rats at post conception day(PCD)9 to induce CDH.The rats were randomized to 5 groups:1)control;2)nitrofen;3)nitrofen+sildenafil 100 mg/kg per day at PCD 16-20;4)nitrofen+bosentan 30 mg/kg per day,at PCD 16-20,and 5)nitrofen+bosentan+sildenafil,same doses and administration days.After cesarean delivery,the offsprings were sacrifi ced.The diaphragmatic defect and pulmonary hypoplasia were identified,and the lungs were dissected.Arterial wall thickness,bronchiolar density and alveolarization were assessed.Results:The offsprings with CDH were characterized by severe pulmonary hypoplasia(lung weight-to-body weight ratio:0.0263[95%confidence interval(CI)0.0242-0.0278)]in the nitrofen group versus 0.0385(95%CI 0.0355-0.0424)in the control group(P=0.0001).Pulmonary arterial wall thickness was decreased to 3.0(95%CI 2.8-3.7)μm in the nitrofen+sildenafil group versus 5.0(95%CI 4.1-4.9)μm in the nitrofen group(P=0.02).Terminal bronchioles increased to 13.7(95%CI 10.7-15.2)μm in the nitrofen+bosentan group in contrast to 8.7(95%CI 7.2-9.4)μm in the nitrofen group(P=0.002).More significant differences(P=0.0001)were seen in terminal bronchioles in the nitrofen+sildenafil+bosentan group than in the nitrofen group[14.0(95%CI 12.5-15.4)μm versus 8.5(95%CI 7.1-9.3)μm].Pulmonary arterial wall thickness was also decreased in the former group.Conclusions:In this rat model,antenatal treatment with sildenafil attenuates vascular remodeling.Bosentan promotes the development of terminal bronchioles in nitrofen-induced CDH.

Predicting Perinatal Outcomes in Fetuses with Congenital Diaphragmatic Hernia Using Ultrasound and Magnetic Resonance Imaging

Congenital diaphragmatic hernia is a congenital fetal disease,which mainly causes pulmonary hypoplasia and pulmonary hypertension.Effective early prenatal diagnosis can detect and predict the prognosis of congenital diaphragmatic hernia in infants,thus provide a reference for prenatal counseling,early intervention,and potential choices for the child’s family.Ultrasound and magnetic resonance imaging are the most commonly used methods for non-invasive examination of the fetus.This paper discusses evaluation parameters based on these two imaging modalities.

Maternal Diaphragmatic Hernia Correction During Pregnancy

Congenital diaphragmatic hernia consists of a defect in the embryonic development of the diaphragm that allows the passage of the abdominal viscera into the thoracic cavity,its diagnosis during pregnancy is quite rare.We present the case of a 31-year-old woman,with 23 weeks of gestation,who consulted for epigastric pain,nausea,and repetitive emetic episodes,without improvement with the medication provided.Due to the intense abdominal pain,a computed tomography of the abdomen and thorax was performed where the 28 mm defect was found at the left diaphragmatic level with protrusion of the gastric fundus to the thoracic cavity.She was taken to surgical management by laparoscopy with abdominal and thoracic approach,with a successful result and without maternal perinatal complications.Although the integrity of the diaphragmatic suture could be feared in relation to the increase in intraabdominal pressure due to uterine growth,the evolution of our patient and previous reports show that postoperative complications are not frequent.Successful vaginal delivery has even been described in some reports.Diaphragmatic hernias diagnosed during pregnancy are quite rare.We suggest that the optimal management of them during pregnancy is immediate surgical correction in case of persistent symptoms,more studies are needed to establish firm recommendations on the management of this pathology.

Combination of congenital cleft lip and palate with congenital diaphragmatic hernia: a severe disease course

Congenital cleft lip and palate （CLP） is the most ＇common birth defect now in China. The incidence is 1.62%0 according to the data （1988-- 1992） provided by the National Center for Birth Defects Monitoring. It is also one of the congenital anomalies that have excellent prognosis. But severe complications may occur in the cases accompanied some other deformities. Here we report a case of death caused by left-sided posterolateral congenital diaphragmatic hernia （CDH）, type Bochdalek, after the cleft operation.

Adult congenital diaphragmatic hernia of the liver: a rare case report

Congenital diaphragmatic hernia (CDH), which mainly occurs in the newborn or in childhood with severe respiratory distress and high mortality, is rarely found in adult, especially for those uncommon right CDH [1–4]. Whereas, liver as the main

Gastroesophageal reflux and congenital gastrointestinal malformations

Although the outcome of newborns with surgical congenital diseases(e.g.,diaphragmatic hernia;esophageal atresia;omphalocele;gastroschisis) has improved rapidly with recent advances in perinatal intensive care and surgery,infant survivors often require intensive treatment after birth,have prolonged hospitalizations,and,after discharge,may have longterm sequelae including gastro-intestinal comorbidities,above all,gastroesophageal reflux(GER).This condition involves the involuntary retrograde passage of gastric contents into the esophagus,with or without regurgitation or vomiting.It is a well-recognized condition,typical of infants,with an incidence of 85%,which usually resolves after physiological maturation of the lower esophageal sphincter and lengthening of the intra-abdominal esophagus,in the first few months after birth.Although the exact cause of abnormal esophageal function in congenital defects is not clearly understood,it has been hypothesized that common(increased intra-abdominal pressure after closure of the abdominal defect) and/or specific(e.g.,motility disturbance of the upper gastrointestinal tract,damage of esophageal peristaltic pump) pathological mechanisms may play a role in the etiology of GER in patients with birth defects.Improvement of knowledge could positively impact the long-term prognosis of patients with surgical congenital diseases.The present manuscript provides a literature review focused on pathological and clinical characteristics of GER in patients who have undergone surgical treatment for congenital abdominal malformations.

新生儿膈疝术后ECMO支持下治疗腹腔间隔室综合征

目的总结新生儿体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)支持下行膈疝修补术后腹腔间隔室综合征(abdominal compartment syndrome,ACS)的处理经验。方法回顾性分析广州市妇女儿童医疗中心1例ECMO支持下行经腹膈疝修补术、术后发生ACS经使用切口保护器行开腹减压术成功救治的患儿临床资料。以"congenital diaphragmatic hernia"、"extracorporeal membrane oxygenation"和"abdominal compartment syndrome"为检索词检索Pubmed、Web of science数据库相关文献;以"先天性膈疝"、"体外膜肺氧合"和"腹腔间隔室综合征"为检索词检索万方医学网、中华医学期刊网及中国知网相关文献;剔除重复病例后进行文献复习,总结新生儿于ECMO下行膈疝修补术后ACS的诊治方法。结果本例患儿于孕中期产检发现胎儿左侧膈疝,产前评估为重度肺发育不良。于39+6周剖宫产娩出,生后收入新生儿外科监护室。因呼吸不能维持,于生后第19小时行ECMO支持,生后第2天在ECMO支持下行经腹膈疝修补术。术后第4天出现ACS经保守治疗无效后于监护室床旁行开腹减压术,术中应用切口保护器保持腹腔开放取得良好效果。开腹减压术后第3天撤离ECMO,第5天关腹,生后第38天痊愈出院,随访至术后4个月无膈疝复发。共检索到相关文献16篇(共报道53例ACS患者),均为英文文献,其中4篇报道了CDH术后合并ACS共6例,其中4例行开腹减压术治疗;另外12篇报道了ECMO术后发生ACS共47例,其中37例行开腹减压术治疗。结论开腹减压术是新生儿于ECMO支持下行膈疝修补术、术后发生ACS的有效外科治疗手段,切口保护器应用于新生儿开腹减压术效果良好,值得推广。

先天性膈疝患儿胸腔镜术后30天死亡的危险因素和列线图模型

目的探索先天性膈疝(CDH)患儿胸腔镜术后30 d死亡的危险因素,并构建列线图风险预测模型。方法选择2020年6月至2023年6月接受胸腔镜膈疝修补术的CDH患儿90例,男62例,女28例,手术时日龄<28 d。根据术后30 d是否存活分为两组:生存组与死亡组。采用差异性分析、单因素Logistic回归进行预测因子筛选,采用多因素Logistic回归分析CDH胸腔镜术后30d死亡的危险因素,构建术后30 d死亡风险列线图预测模型,采用ROC曲线、Bootstrap法、决策曲线分析该模型的预测效能、校准度以及决策能力。结果有28例(31%)CDH患儿在胸腔镜下膈疝修补术后30 d死亡。多因素Logistic回归分析显示:产前诊断时间≤25周、低体重儿、术前高频振荡通气(HFOV)、术前氧合指数(OI)增加、开腹手术、肝脏疝入胸腔是CDH患儿术后30 d死亡的独立危险因素(P<0.05)。基于上述独立危险因素构建CDH患儿术后30 d死亡风险的列线图预测模型,结果显示,该模型AUC为0.959(95%CI 0.9107~1.0000),当截断值为0.361时,敏感性为92.9%,特异性为91.9%,约登指数为0.848,C-index为0.917,提示该模型预测能力较好;决策曲线显示,该模型的阈值概率为0.01~1.00,其净收益率>0,且均高于两条无效线。结论产前诊断时间≤25周、低体重儿、术前HFOV、术前OI增加、开腹手术、肝脏疝入胸腔为CDH患儿胸腔镜术后30 d死亡的独立危险因素,基于此构建的列线图预测模型对CDH患儿胸腔镜术后30 d死亡有较好预测价值。

孕鼠产前川芎嗪灌胃对先天性膈疝胎鼠肺组织发育及Hippo信号通路蛋白表达的影响

目的通过观察孕鼠产前川芎嗪灌胃对先天性膈疝胎鼠肺组织发育及Hippo信号通路蛋白表达的影响,初步探讨川芎嗪产前干预对先天性膈疝胎鼠的保护作用及其机制。方法SD大鼠按照雌雄2∶1的比例分笼夜间交配,于孕鼠妊娠9.5 d时随机分为正常对照组、模型对照组、模型+川芎嗪组各5只。模型对照组及模型+川芎嗪组在分组后立即给予除草醚一次性灌胃建立胎鼠膈疝模型,正常对照组给予等量橄榄油灌胃。模型+川芎嗪组从妊娠11.5 d开始给予80 mg/(kg·d)的川芎嗪一次性灌胃给药直至妊娠21 d,正常对照组、模型对照组给予等量蒸馏水灌胃。所有孕鼠于妊娠21.5 d行剖宫产取出胎鼠,取出胎鼠两侧肺组织观察有无膈疝,选择模型对照组及模型+川芎嗪组仅有左侧膈疝的胎鼠肺组织进行研究,取正常对照组胎鼠的左侧肺组织作为正常对照。HE染色及血管特殊染色观察各组肺组织形态和肺泡发育指标辐射状肺泡计数(RAC)、肺泡面积百分比、肺泡间隔厚度,以及肺血管发育指标血管外径、血管中膜百分比、血管壁肌化程度。Western blotting法检测各组肺组织Hippo信号通路相关蛋白Yap、Lats1、磷酸化Yap(p-Yap)表达。结果HE染色显示,与正常对照组比较,模型对照组胎鼠肺组织发育明显滞后,肺泡、肺泡囊及肺泡管均呈假腺体样结构,肺泡间隔及腺泡内动脉壁增厚;与模型对照组比较,川芎嗪干预组胎鼠肺组织发育有明显改善。模型对照组RAC、肺泡面积百分比小于正常对照组,肺泡间隔厚度大于正常对照组;模型+川芎嗪组RAC、肺泡面积百分比大于模型对照组,肺泡间隔厚度小于模型对照组(P均<0.05)。模型对照组血管中膜百分比高于正常对照组,血管壁未肌化程度低于正常对照组;模型+川芎嗪组血管中膜百分比低于模型对照组,血管壁未肌化程度高于模型对照组(P均<0.05)。模型对照组、模型+川芎嗪组Yap蛋白表达高于正常对照组,模型+川芎嗪组Lats1、p-Yap蛋白表达高于正常对照组、模型对照组(P均<0.05)。结论川芎嗪产前干预可改善先天性膈疝胎鼠的肺组织发育不良并促进Hippo信号通路蛋白Lats1表达及Yap磷酸化,从而发挥对肺组织的保护作用。

胸腔镜联合快速康复方案治疗儿童先天性膈疝

目的评价快速康复(ERAS)方案在胸腔镜治疗儿童先天性膈疝的临床效果。方法回顾性分析2010年1月至2020年1月收治的先天性膈疝52例,按是否接受快速康复方案分为对照组和ERAS组,快速康复方案主要包括:围术期护理、饮食管理、血液管理、麻醉管理、营养支持、疼痛管理等。对比分析2组患儿术中出血量、手术时间、术后并发症发生率、生活质量等指标。结果ERAS组纳入患儿25例,对照组患儿27例,统计结果显示2组患儿性别、膈疝侧别、出生时体重、手术日龄等指标差异无统计学意义(P>0.05);ERAS组和对照组平均手术时间及术中出血量为[(119±24)min vs(117±19)min,P=0.603;(6.0±2.5)ml vs(7.2±3.1)ml,P=0.006]。2组平均随访时间为(7.3±4.1)年,ERAS组术后并发症发生率低于对照组,生活质量PedsQL 4.0评分高于对照组,组间对比差异统计学意义(P<0.05)。结论ERAS方案可降低胸腔镜治疗先天性膈疝的术中出血和术后并发症发生率,同时提高了此类患儿术后的生活质量。

胸腔镜下牛心包补片修补巨大先天性膈疝的疗效与安全性分析

目的探讨胸腔镜下牛心包补片修补巨大先天性膈疝(congenital diaphragmatic hernia,CDH)的可行性及安全性。方法回顾性分析2018年6月至2020年1月广东省妇幼保健院新生儿外科收治的5例巨大CDH患儿临床资料,患儿均采用胸腔镜下牛心包补片修补巨大膈肌缺损,出院后经门诊或电话随访。收集并分析围手术期临床资料、手术情况及随访结果,评价胸腔镜下采用牛心包补片修补巨大CDH的疗效。结果5例CDH患儿中,4例为左侧膈疝,1例为右侧膈疝;均为无疝囊的巨大膈疝。C级缺损4例,D级缺损1例。均采用胸腔镜下牛心包补片进行修补,其中1例中转开腹手术;手术时间120~210 min,平均160 min;住院时间23~50 d,平均34 d;无一例围手术期死亡病例。术后随访1~3年,无一例复发;随访胸片提示患侧膈肌及肺生长良好,纵隔、横膈正常,生长发育良好。结论胸腔镜下牛心包补片修补巨大CDH手术安全性高,疗效可靠,可作为临床修补巨大CDH的有效治疗手段。

多学科诊疗模式下先天性膈疝患儿的临床转归

目的探讨多学科诊疗模式下先天性膈疝(congenital diaphragmatic hernia,CDH)的临床转归以及预后相关因素。方法本研究为回顾性研究。以2016年1月至2022年8月首都儿科研究所附属儿童医院收治的103例产前诊断为CDH的患儿为研究对象,以出生24 h内出现体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)使用指征为分组标准,将患儿分为ECMO达标组和非ECMO达标组,其中ECMO达标组39例,非ECMO达标组64例。分析两组患儿临床预后、超声心动图表现,以及ECMO达标组患儿死亡风险因素。结果103例患儿总病死率为29.1%(95%CI:20.6%~38.9%)。ECMO达标组病死率为53.9%(95%CI:37.2%~69.9%),高于非ECMO达标组的14.1%(95%CI:6.6%~25.0%),该组存活患儿有创呼吸机使用时间为336.5(160.5,578.5)h,住院时长为37.5(22.8,51.3)d。非ECMO达标组有创呼吸机使用时间为177.0(121.0,311.0)h、住院时长为25(19,34)d。与非ECMO达标组相比,ECMO达标组右侧膈疝占比更多,肝脏疝入发生率更高,膈肌缺损程度更大(P<0.05),早期肺动脉高压更严重(P<0.01),右心增大(69.7%比27.3%,P<0.01)以及左心功能不全(18.2%比0,P<0.01)的发生率更高。多因素回归分析结果显示,诊断胎龄<25周、动脉二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO_(2))偏高、氧合指数(oxygenation index,OI)偏大是ECMO达标组CDH患儿死亡的独立危险因素(P<0.05)。结论在CDH患儿诊治中,采取产前-产时-产后一体化诊疗模式,优化通气管理和血管活性药物的精准个性化使用,可获得与ECMO中心相仿的治疗效果。建议ECMO在CDH患儿中的使用更加谨慎。患儿诊断胎龄早及生后早期氧合功能差与死亡结局密切相关。

胸腔镜手术和传统开放手术治疗新生儿先天性膈疝的单中心研究

目的比较胸腔镜手术和传统开放手术治疗先天性膈疝(congenital diaphragmatic hernia,CDH)的临床疗效、安全性和有效性。方法回顾性分析遵义医科大学附属医院2013年6月至2020年6月收治的37例CDH患儿临床资料,根据手术方式分为腔镜手术组和开放手术组。其中腔镜手术组24例,采用胸腔镜手术治疗CDH;开放手术组13例,采用传统开放手术治疗CDH。两组患儿一般资料和膈疝特征比较,差异无统计学意义(P>0.05)。主要观察指标包括复发率、住院天数、手术时长、术后机械通气时间、术后开奶时间、达到目标喂养时间;次要观察指标包括手术切口感染情况、术中出血量、膈疝口径大小。结果腔镜手术组与开放手术组患儿住院天数[(13.46±2.41)d比(18.77±2.89)d]、术后机械通气时间[(3.81±0.80)d比(5.98±1.06)d]、术后开奶时间[(4.35±1.03)d比(7.46±1.45)d]、达到目标喂养时间[(8.33±1.74)d比(13.38±2.22)d]比较,差异均有统计学意义(P<0.001);两组复发率(1/24比1/13)差异无统计学意义(P=1.000);开放手术组死亡1例,腔镜手术组无一例死亡,差异无统计学意义(P>0.05)。结论腔镜下CDH修补术具有手术时间短、创伤小、切口美观、术后恢复快、复发率低等优点,是一种安全、有效的手术方式,有望成为治疗CDH的首选术式。

新生儿先天性消化道畸形334例临床诊治分析

目的 探讨不同类型新生儿先天性消化道畸形的临床表现及治疗情况,以提高该病的诊断治疗效果。方法 选取2015年1月1日至2019年8月31日在西北妇女儿童医院新生儿重症监护室住院治疗的334例先天性消化道畸形患儿作为研究对象。回顾性分析患儿的临床资料,分析不同畸形类型患儿的临床表现、产前诊断、手术治疗情况及预后。结果 新生儿先天性消化道畸形主要包括肛门闭锁、食道闭锁和食管气管瘘、先天性空肠或回肠闭锁、十二指肠闭锁或狭窄、肥厚性幽门狭窄、膈疝。肛门、食道、肠道闭锁等以呕吐、腹胀为主要临床表现,膈疝以呼吸费力、发绀为主要临床表现。产前B超检查对新生儿先天性消化道畸形的早期诊断具有重要意义,手术治疗为主要治疗方法。结论 临床应普及优生优育知识,夫妻双方妊娠期间改变吸烟、饮酒等不良生活习惯,加强产前咨询,正规产前检查,尽可能降低新生儿先天性消化道畸形发生率。新生儿出生后应早期识别、诊断先天性消化道畸形,及早转入专科医院进行手术治疗,进而改善预后,降低病死率。

手术治疗新生儿先天性膈疝临床疗效及预后的相关预测因素

目的分析经手术治疗新生儿先天性膈疝(congenital diaphragmatic hernia,CDH)临床疗效及预后的相关预测因素。方法回顾性分析本院2018年4月至2019年5月收治且经临床检查确诊的93例CDH患儿的临床资料。记录患儿出生后1 min及5 min的Apgar评分、动态血气分析结果、平均住院时间、呼吸机使用时间、ICU平均住院时间及术后并发症发生等情况,分析影响患儿预后的危险因素。结果治疗后,患儿pH值、气道峰压明显低于治疗前,动脉血二氧化碳分压(partial pressure of carbon dioxide in artery,PaCO_(2))、呼气末二氧化碳分压(end-tidal carbon dioxide pressure,ETCO_(2))值显著高于治疗前,差异有统计学意义(P<0.05)。术后反复肺部感染13例(12.98%),肺不张5例(5.38%),心包积液、胃食管反流各1例(1.08%),术后复发1例(1.08%);预后良好79例,预后不良14例;经非条件多因素logistic回归模型分析,早产儿、严重心脏畸形、新生儿持续肺动脉高压(persistent pulmonary hypertension in neonates,PPHN)、pH值及入院PaCO_(2)、动脉血氧分压(partial pressure of oxygen in arterial blood,PaO_(2))值是影响CDH患儿预后不良的独立危险因素(P<0.01)。结论导致CDH患儿预后不良的因素较多,为了更好地改善患儿的预后情况,需要对合并危险因素者早期采取预防手段。