腔镜手术与开放手术治疗新生儿膈疝的临床效果及对并发症的影响  

Clinical effect of endoscopic surgery and open surgery in the treatment of neonatal diaphragmatic hernia and its influence on complications

作　　者：覃宇冰[1] 杨振宇[1] 杨国柱 QIN Yubing;YANG Zhenyu;YANG Guozhu(Department of Pediatric Surgery,the First Affiliated Hospital of Xiamen University,Xiamen361003,China)

机构地区：[1]厦门大学附属第一医院儿外科,福建厦门361003

出　　处：《中国现代医生》2021年第9期78-81,共4页China Modern Doctor

摘　　要：目的研究腔镜手术与开放手术在新生儿膈疝治疗中的效果及对并发症的影响。方法回顾性收集2012年1月至2020年2月在本院新生儿科诊治的新生儿膈疝40例,根据手术方法分为腔镜组(n=20)和开放组(n=20),腔镜组患儿应用腔镜下膈疝修补术治疗,开放组患儿应用开放性膈疝修补术治疗,比较两组患儿手术指标、术后恢复指标、并发症发生情况及复发率。结果腔镜组患儿手术时间长于开放组,差异有统计学意义(P<0.001);腔镜组患儿手术切口长度、术中出血量、机械通气时间、抗生素使用时间、术后住院时间均低于开放组,差异有统计学意义(P<0.001);两组患儿术中输血率、术中使用补片率、胸腔积液率、术后24 h PCO2水平比较,差异均无统计学意义(P>0.05);腔镜组并发症总发生率(10.00%)低于开放组(40.00%),差异有统计学意义(P<0.05);腔镜组术后3个月复发率为5.00%,略高于开放组的0,差异无统计学意义(P>0.05)。结论腔镜下膈疝修补术在新生儿膈疝治疗中疗效肯定,手术对患儿的创伤小,术后并发症少,利于患儿早日康复,值得临床推广。Objective To study the effect of endoscopic surgery and open surgery in the treatment of neonatal diaphragmatic hernia and its influence on complications.Methods A total of 40 cases of neonatal diaphragmatic hernia diagnosed and treated in our hospital from January 2012 to February 2020 were collected retrospectively,and they were divided into the endoscopic group(n=20)and the open group(n=20)according to the surgical methods.Children in the endoscopic group were treated with endoscopic diaphragmatic hernia repair,while children in the open group were treated with open diaphragmatic hernia repair.The operation indexes,postoperative recovery indexes,complications and recurrence rate of the two groups were compared.Results The operation duration of children in the endoscopic group was longer than that in the open group,the difference was statistically significant(P<0.001).The length of operation incision,intraoperative hemorrhage volume,mechanical ventilation time,antibiotic use time and postoperative hospitalization time in the endoscopic group were lower than those in the open group,the differences were statistically significant(P<0.001).There were no significant differences in blood transfusion rate,patch rate,pleural effusion rate and PCO2 level 24 hours after operation between the two groups(P>0.05).The total incidence of complications in endoscopic group(10.00%)was lower than that in open group(40.00%),the difference was statistically significant(P<0.05).The recurrence rate 3 months after operation in the endoscopic group was 5.00%,slightly higher than 0 in the open group,and the difference was not statistically significant(P>0.05).Conclusion The application of endoscopic diaphragmatic hernia repair has certain therapeutic efficacy in the treatment of neonatal diaphragmatic hernia.It has less trauma to pediatric patients and less incidence of postoperative complications,which is conducive to the early recovery of pediatric patients and is worthy of clinical promotion.

关 键 词：腔镜手术 开放性手术 膈疝修补术 新生儿膈疝 并发症 复发率 

分 类 号：R726.5[医药卫生—儿科]