腔镜手术治疗婴幼儿膈膨升24例临床分析  

Analysis of 24 infants with diaphragmatic eventration treated by minimally invasive surgery

作　　者：胡吉梦[1] 吴晔明[1] 王俊[1] 张弛[1] 严文波[1] 潘伟华[1] 周莹[1] 

机构地区：[1]上海交通大学医学院附属新华医院小儿外科,200092

出　　处：《中华小儿外科杂志》2013年第11期810-813,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨婴幼儿膈膨升症的临床特点、诊断及不同手术路径和术式的选择。方法本文回顾性分析2008年11月至2013年4月我院小儿外科收治的膈膨升患儿24例临床资料，男女比例3：1，年龄范围2个月至3岁，其中右侧膈膨升20例，左侧膈膨升4例，22例行胸腔镜下膈肌折叠术，2例行腹腔镜下膈肌折叠术。共采用3种不同腔镜下膈肌折叠术式，门诊随访时间2～35个月。结果24例患儿手术均在胸腔镜下或腹腔镜下顺利完成，无中转开胸或中转开腹病例，无术中并发症，术后复查胸片提示膈肌较术前下降1～4．5个肋间隙（平均2．7个肋间隙），术后3个月门诊复查胸片提示横膈有轻微再升高现象，但均在1个肋间隙范围内。结论微创手术治疗膈膨升安全有效，具有创伤小，恢复快，治疗效果满意等优点，外科医生应根据临床经验、操作技能及手术室条件选择合理的手术路径及术式。Objective To discuss the clinical feature, diagnosis and surgical management for in- {ants with diaphragmatic eventration. Methods This study retrospectively analyzed the clinical data of patients with diaphragmatic eventration during November 2008 to April 2013. The male to female ratio was 3 ： 1, with age at presentation ranged from 3 months to 3 years. Twenty of them had right-sided e- ventration, 4 had left-sided eventration. Twenty-two patients were repaired thoracoscopically while the other 2 patients had laparoscopic approach. Three different plication techniques were used. Fol- low-up time ranged from 2 to 35 months. Results All patients successfully underwent minimally inva- sire surgery with no conversion. Post-operatively, the diaphragm descended between 1 to 4. 5 inter- costal spaces （mean distance of 2. 7 intercostal spaces）. During 3-month follow-up, chest radiographs showed only a slight rise of the diaphragm within one intercostal space. Conclusions Minimally inva sive surgery to treat diaphragmatic eventration is feasible and has significant advantages such as little trauma, quick recovery, and parental satisfaction.

关 键 词：膈膨出 婴幼儿 胸腔镜 腹腔镜 

分 类 号：R726.5[医药卫生—儿科]