腹腔镜下膈肌折叠术治疗小儿先心病术后膈膨升  

Laparoscopic diaphragmatic hemiplication in children with diaphragmatic eventration post congenital heart surgery

作　　者：曹国庆[1] 雷海燕[1] 汤绍涛[1] 阳历[1] 李帅[1] 张茜[1] 王新星[1] 李康[1] 杨德华[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院小儿外科,湖北省武汉市430022

出　　处：《临床小儿外科杂志》2016年第1期56-58,共3页Journal of Clinical Pediatric Surgery

基　　金：卫计委公益性行业科研项目基金资助;项目号:201402007

摘　　要：目的介绍腹腔镜技术治疗／],JL先心病术后膈膨升的手术方法并探讨其安全性和疗效。方法自2007年至2014年，我们收治20例先心病术后膈膨升患儿，其中左侧13例，右侧7例，平均年龄9．5个月。采用腹腔镜三孔法完成膈肌折叠术，必要时在左上腹放-3mm Troear辅助牵拉。探查膈肌后，用2—0不可吸收带针缝线自左腹壁穿入腹腔，尾线留在腹壁外，间断“手风琴”式膈肌折叠缝合。采用腹腔内绕线、腹腔外牵拉尾线辅助打结，效果不满意时缝合两层，使膈肌平直并下降至正常水平。结果20例均在腹腔镜下完成手术，平均手术时间60min，出血量5mL。术后24～48h进食。出院前复查立位胸片，患侧膈肌下降至正常水平，无术中术后并发症。术后平均随访14．5个月，1个月、3个月复查胸片膈肌位置无明显改变，呼吸道症状明显缓解，无复发病例。结论腹腔镜下膈肌折叠术治疗小儿先心病术后膈膨升操作方便，安全性好，疗效确切。Objetive To report our experiences in the laparoseopic diaphragmatic hemiplication （LDHP） with the pleating technique in children with acquired diaphragmatic eventration post congenital heart surgery. Methods From 2007 to 2014,20 children post congenital heart surgery suffered from diaphragmatic elevation, 13 cases left side and 7 cases right side. Mean age was 9.5 months. All these patients underwent a LDHP procedure with three 5 mm troears, but sometime an additional 3 mm port was inserteded in the upper left quadrant of the abdomen for additional assistance. After a quick assessment of the abdomen,2-0 non-absorbable ETHIBOND Excel Polyester suture was introduced into the peritoneal cavity through the anterior abdominal wall near the costal arch with the suture tail left outside the abdominal wall. The diaphragm begun to fold and pleat on each other like a closing accordion. Pulling the suture tail outside helped us to tie the knot intraeorporally, sometimes we stitched an additional pleat when the tautness was unsatisfactory, which made the diaphragm straight and dropped to normal level. Results The operation was completed laparoseopieally for all these pa- tients, the mean operative time was 60 min with minimal blood lost 5 ml. Chest X-ray before discharge showed that the diaphragm of operative side dropped to normal level, no intra-or post-operative complications, Oral feed- ing was started 24 hours post operative. The follow-up was 14.5 months ,without recurrence of diaphragmatic e- ventration. Conclusions LDHP is simple, convenient and effective in selected patient after congenital heart surgery where surgical diaphragmatic plieation is indicated.

关 键 词：腹腔镜检查 心脏病/先天性 膈 儿童 

分 类 号：R726.5[医药卫生—儿科]