胸腔镜简易褥式缝合法治疗无膈肌后缘的新生儿膈疝  

Thoracoscopic repair with simplified mattress sutures in the treatment of diaphragmatic hernia in neonates without posterolateral rim of diaphragm

作　　者：李炳 陈卫兵 夏顺林 刘孟旭 王寿青 Li Bing;Chen Weibing;Xia Shunlin;Liu Mengxu;Wang Shouqing(Department of Pediatric Surgery,the Women and Children′s Hospital of Huai′an,Huai′an,Jiangsu,223002,China)

机构地区：[1]淮安市妇女儿童医院小儿外科,江苏省223002

出　　处：《中国基层医药》2020年第5期550-554,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨胸腔镜下应用注射器带线简易褥式缝合法治疗无膈肌后缘新生儿膈疝的初步经验。方法回顾性分析淮安市妇女儿童医院2015年3月至2017年10月采用胸腔镜下注射器针头带线的简易褥式缝合法治疗无膈肌后缘膈疝患儿10例的临床资料,其中男6例,女4例;入院年龄10 min至1 d。足月儿7例,早产儿3例。体质量2.3~3.5 kg(平均2.88 kg),均为左侧膈疝。在裂隙的体表投影处肋间取2~3个预备缝合部位,切开皮肤1 mm,两根2-0不可吸收缝线绕过相应肋骨,通过注射器针头分次插入膈肌缺损的前缘的肌肉之间,第一根线头由第二根线环带出体外进行打结,关闭后外侧裂隙,线结位于肋间皮下。结果在胸腔镜膈疝修补术的实施过程中,10例膈疝患儿均应用该简化技术成功修复无膈肌后缘的新生儿膈疝后外侧裂隙。手术时间为25~60 min(平均37.5 min)。10例患儿随访3~33个月(平均16.5个月),无死亡和复发病例。1例新生儿术后合并皮下气肿术后1周消失。结论胸腔镜下应用注射器带线简易褥式缝合法治疗无膈肌后缘的新生儿膈疝是一个有效而且可靠的技术,具有操作简单,手术时间短,效果确切等优点。Objective To explore the initial experience of thoracoscopic repair with simplified mattress sutures in the treatment of diaphragmatic hernia in neonates without posterolateral rim of diaphragm.Methods A retrospective review of the new simplified technique in 10 cases from March 2015 to October 2017 was performed.Of the patients,6 cases were male,4 cases were female.The age was 10min-1d,7 cases were term newborns,and 3 cases were premature.The mean weight was 2.88 kg(ranged 2.3-3.5kg).All the 4 cases were left-sided.Two to three primary suture sites were taken from the relative intercostal region of the body surface projection of the defect.A snip incision about 1 mm of the skin was done.Two 2-0 non-absorbable sutures round the rib were inserted between the front edged of the defect and the diaphragm muscle through a syringe needle.The first thread was brought out of the body by the ring of the second thread and knot tying was made extracorporally.The posterolateral defect was closed;the knot was under the skin of intercostals space.Results Ten neonates with CDH were repaired successfully using this new simplified technique.The mean operative time was 37.5min(ranged 25-60min)for each CDH repair.No cases required conversion to open surgery,blood loss was minimal.The 10 cases were followed up for 16.5 months(ranged 5-24 months),with no death and no recurrence.One neonate complicated with subcutaneous emphysema postoperatively and healed in one week.Conclusion The new technique of thoracoscopic repairing with simplified mattress sutures when no posterolateral rim of diaphragm exists has all the advantages of thoracoscopy in neonates combined with the advantages of reduced operative time,simplicity,feasibility and definite curative effect and has the value of clinical popularization.

关 键 词：疝 横膈 胸腔镜检查 修复外科手术 婴儿 新生 

分 类 号：R722[医药卫生—儿科]