Surgical management of the diaphragmatic defect in congenital diaphragmatic hernia:a contemporary review  

作　　者：Marietta Jank Michael Boettcher Richard Keijzer 

机构地区：[1]Division of Pediatric Surgery,Departments of Surgery and Pediatrics&Child Health,Max Rady College of Medicine,Rady Faculty of Heath Sciences,University of Manitoba,Children's Hospital Research Institute of Manitoba,Winnipeg,Manitoba,Canada [2]Department of Pediatric Surgery,University Medical Centre Mannheim,Heidelberg University,Mannheim,Germany

出　　处：《World Journal of Pediatric Surgery》2024年第3期187-197,共11页世界小儿外科杂志（英文）

基　　金：MJ(519368454)is a holder of the Walter-Benjamin scholarship from the German Research Fund(DFG,Deutsche Forschungsgemeinschaft).

摘　　要：Worldwide,150 children are born each day with congenital diaphragmatic hernia(CDH),a diaphragmatic defect with concomitant abnormal lung development.Patients with CDH with large defects are particularly challenging to treat,have the highest mortality,and are at significant risk of long-term complications.Advances in prenatal and neonatal treatments have improved survival in high-risk patients with CDH,but surgical treatment of large defects lacks standardization.Open repair by an abdominal approach has long been considered the traditional procedure,but the type of defect repair(patch or muscle flap)and patch material(non-absorbable,synthetic or absorbable,biological)remain subjects of debate.Increased experience and improved techniques in minimally invasive surgery(MIS)have expanded selection criteria for thoracoscopic defect repair in cardiopulmonary stable patients with small defects.However,the application of MIS to repair large defects remains controversial due to increased recurrence rates and unknown long-term effects of perioperative hypercapnia and acidosis resulting from capnothorax and reduced ventilation.Current recommendations on the surgical management rely on cohort studies of varying patient numbers and data on the long-term outcomes are sparse.Here,we discuss surgical approaches for diaphragmatic defect repair highlighting advancements,and knowledge gaps in surgical techniques(open surgery and MIS),patch materials and muscle flaps for large defects,as well as procedural adjuncts and management of CDH variants.

关 键 词：PATCH DEFECT REPAIR 

分 类 号：R726[医药卫生—儿科]