胸、腹腔镜联合手术治疗小婴儿先天性膈疝  

Thoracoscopic and laparoscopic surgery for congenital diaphragmatic hernia in infants

作　　者：吴茂军[1] WU Mao-jun(Department of Pediatric Surgery,Affiliated Hospital of Taishan Medical University, Taian 271000, China)

机构地区：[1]泰山医学院附属医院,山东泰安271000

出　　处：《腹腔镜外科杂志》2016年第11期869-871,共3页Journal of Laparoscopic Surgery

摘　　要：目的：探讨胸、腹腔镜联合手术治疗小婴儿先天性膈疝的可行性及治疗效果。方法：回顾分析2014年8月至2016年5月胸、腹腔镜联合手术治疗3例小婴儿先天性膈疝的临床资料,均为左后外侧疝,年龄分别为5个月、8个月、19个月。其中1例伴肠旋转不良,术中经腹腔镜处理。3例患儿先经腹腔镜疝内容物复位,再经胸腔镜行膈疝修补。结果：手术均顺利完成,手术时间分别为115 min、106 min、110 min。术中出血量3~5 ml,经腋前线第7肋间Trocar孔放置胸腔闭式引流。术后1周内复查胸片,心脏复位良好,肺膨胀良好。术后随访1~6个月无复发,患儿呼吸急促、呼吸困难症状消失,食欲好,体重增加明显。结论：胸、腹腔镜联合手术治疗小婴先天性膈疝操作方便,创伤较小,手术操作更加安全;同时能兼顾腹部,避免了因消化道畸形再次手术的可能。手术效果令人满意,也可作为备选的治疗方式。Objective： To explore the feasibility and therapeutic effect of thoracoscopic and laparoscopic surgery in the treatment of congenital diaphragmatic hernia in infants. Methods： Retrospective analysis was made on the clinical data of 3 infants with congenital diaphragmatic hernia who underwent thoracoscopic and laparoscopic surgery from Aug. 2014 to May 2016. All cases were the left posterior lateral hernia with the age of 5 months,8 months and 19 months respectively. One child with poor bowel rotation underwent laparoscopic treatment. 3 children firstly received laparoscopic reduction of hernia content and then thoracoscopic diaphragmatic hernia repair. Results： All operations were successfully completed without intra-operative and post-operative complication. Operative time was115 min,106 min and 110 min respectively. The blood loss was 3-5 ml. The thoracic closed drainage tube was placed at anterior axillary line of 7th intercostal space. Chest radiograph within 1 week postoperatively showed satisfying cardiac reduction and lung expansion. Patients were followed up for 1-6 months without recurrence,polypnea or dyspnea,infants appeared good appetite and significant weight gain. Conclusions： Thoracoscopic and laparoscopic surgery in the treatment of congenital diaphragmatic hernia for infants is convenient,mini-invasive and secure. Because this procedure can treat abdominal diseases at the same time,re-operation for gastrointestinal malformations could be avoided. It is an alternative treatment with satisfactory surgical results.

关 键 词：疝 横膈 胸腔镜检查 腹腔镜检查 婴儿 

分 类 号：R726.5[医药卫生—儿科]