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  

Thoracoscopic repair of giant congenital diaphragmatic hernia with bovine pericardial patch

作　　者：田松[1] 李艳 陈嘉颖 朱小春[1] 肖尚杰[1] 葛午平[1] Tian Song;Li Yan;Chen Jiaying;Zhu Xiaocun;Xiao Shangjie;Ge Wuping(Department of Neonatal Surgery,Municipal Women&Children's Hospital,Guangzhou 511400,China)

机构地区：[1]广东省妇幼保健院新生儿外科,广州511400

出　　处：《临床小儿外科杂志》2023年第11期1077-1081,共5页Journal of Clinical Pediatric Surgery

基　　金：广东省科技厅科技计划项目(2017ZC0315)

摘　　要：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。Objective To investigate the feasibility and safety of repair large congenital diaphragmatic hernia with bovine pericardial mesh under thoracoscopy,and to evaluate the long-term efficacy of diaphragmatic hernia surgery.Methods From June 2018 to January 2020,the clinical data of 5 cases with large CDH were collected.All the patients were repaired with bovine pericardial patch under thoracoscope,and were followed up by outpatient service or telephone after discharge.To analyze the perioperative data,operation status and follow-up results,and evaluate the effect of repair giant congenital diaphragmatic hernia with bovine pericardial mesh under thoracoscopy.Results Four cases showed left diaphragmatic hernia,one case presented right diaphragmatic hernia.All 5 case were giant diaphragmatic hernias without hernia sac,four neonates had a"C"defect,one neonate had a"D"defect.All patients were repaired with bovine pericardium patch thoracotomy,The operative time ranged from 120 to 210minutes(mean,160minutes),and hospitalization time was 23-50 d(mean,34 d).None of them died during perioperative period.During a follow up period of 1 to 3 years,there was no recurrence cases,chest radiographs showed good growth of diaphragm and lung,normal mediastinum,and good growth and development of the child.Conclusions Thoracoscopic repair large CDH with bovine pericardial patch is safe and effective,and can be used as an effective means to repair giant congenital diaphragmatic hernia.

关 键 词：先天性膈疝 牛心包补片 胸腔镜手术 外科手术 儿童 

分 类 号：R726.5[医药卫生—儿科]