腹腔镜下膈肌折叠术治疗小儿先天性右侧膈膨升的疗效分析  

Case analysis of the effectiveness of laparoscopic diaphragmatic plication to treat the children with congenital right-sided diaphragm eventration

作　　者：马立东[1] 李春雷[1] 周福金[1] 

机构地区：[1]辽宁省沈阳市儿童医院外科

出　　处：《临床小儿外科杂志》2015年第4期307-309,共3页Journal of Clinical Pediatric Surgery

摘　　要：目的探讨腹腔镜下膈肌折叠术治疗小儿先天性右侧膈膨升的可行性。方法选取2002年1月至2013年12月于本院诊断为右侧膈膨升，并行膈肌折叠术的患儿17例，其中7例采取开放性手术（均经腹完成手术），为开放手术组；10例采取腔镜手术，为腹腔镜手术组。结果17例手术均获成功，术后胸片（DR）复查膈肌反常运动消失，Kienbock征均为阴性。治愈16例中，经开放手术治愈6例，腹腔镜手术治愈10例。开放手术组平均手术时间145min，术后住院时间（11．19±2．29）d，术后1例并发切口感染，经换药至切口愈合出院；腹腔镜手术组平均手术时间130min，术后住院时间（8．86±2．31）d，无一例发生并发症。随访半年至2年，无一例复发。结论腹腔镜治疗膈膨升相对安全，创口小，恢复快，效果满意，且可实现对腹腔其他脏器的探查，是值得推广的微创手术方式。Objetive To investigate the feasibility of the treatment of laparoscopic diaphragmatic plication of right side congenital diaphragmatic eventration. Methods To choose 17 cases who were diagnosed as ＂the right side congenital diaphragmatic eventration＂ and treated by the surgery of diaphragmatic plication from January 2002 to December 2013 in our hospital inpatient, in which 7 cases undergoing with open surgery （abdominal surgical approach）, 10 routine endoscopic surgery. Results Diaphragmatic plication surgery were successful in treating these 17 cases of children with diaphragmatic eventration, DR reviewed that paradoxical diaphragmatic movement disappeared and Kienbock sign were negative postoperative. 16 patients were cured, including six cases of open surgery, in which one case in one month old neonatal died of respiratory failure due to severe pneumonia at 11 days after open surgery ; 10 cases of laparoscopic surgery were all cured. Mean operative time was 145 minutes in open surgery group, postoperative hospital stay （11.19 ± 2. 29） d. 1 case of concurrent postoperative wound infection, dressing to wound healing to discharged. Laparoscopic surgery time was 130 minutes on average, postoperative hospital stay （8. 86 ± 2. 31 ） d, no complications. Follow-up of six months to two years without recurrence. Conclusions Laparoscopic diaphragm eventration is relatively safe, small incision, quick recovery, satisfactory results can be achieved and could have an exploration of other organs in abdominal cavity, is worthy of promotion and application of minimally invasive surgical techniques.

关 键 词：腹腔镜 膈膨出 治疗结果 儿童 

分 类 号：R726.5[医药卫生—儿科]