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

中国基层医药 Pub Date : 2020-03-01 DOI:10.3760/CMA.J.ISSN.1008-6706.2020.05.009

Bing Li, Wei-bing Chen, Shunlin Xia, Mengxu Liu, Shou-qing Wang

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Abstract

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. Key words: Hernia, diaphragmatic; Thoracoscopy; Reconstructive surgical procedures; Infant, newborn

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胸腔镜下简易床垫缝合线治疗无膈后外侧缘新生儿膈疝

目的探讨胸腔镜下简易床垫缝合线治疗无膈后外侧缘新生儿膈疝的初步经验。方法回顾性分析2015年3月至2017年10月10例新简化手术的临床资料。其中男性6例，女性4例。年龄10min-1d，足月新生儿7例，早产儿3例。平均体重2.88 kg(2.3-3.5kg)。4例均为左侧。从缺损体表投影的相对肋间区取2 - 3个主要缝合点。在皮肤上剪开约1mm的切口。用注射针将两根2-0型不可吸收缝合线绕肋插入缺损前缘与膈肌之间。第一根线被第二根线的环带出身体，结是在体外打结的。后外侧缺损闭合;结在肋间隙皮下。结果10例新生儿CDH采用简化后的方法成功修复。每次CDH修复平均手术时间37.5min(范围25 ~ 60min)。没有病例需要转开腹手术，出血量最小。10例患者随访16.5个月(5 ~ 24个月)，无死亡和复发。1例新生儿术后并发皮下肺气肿，1周内痊愈。结论无膈后外缘胸腔镜下简易床垫缝合线修补新技术具有新生儿胸腔镜手术的全部优点，且手术时间短、操作简便、可行、疗效明确，具有临床推广价值。关键词:疝;膈肌;胸腔镜检查;重建外科手术;婴儿,新生

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来源期刊

中国基层医药

CiteScore

0.10

自引率

0.00%

发文量

32251

期刊介绍： Since its inception, the journal "Chinese Primary Medicine" has adhered to the development strategy of "based in China, serving the grassroots, and facing the world" as its publishing concept, reporting a large amount of the latest medical information at home and abroad, prospering the academic field of primary medicine, and is praised by readers as a medical encyclopedia that updates knowledge. It is a core journal in China's medical and health field, and its influence index (CI) ranks Q2 in China's academic journals in 2022. It was included in the American Chemical Abstracts in 2008, the World Health Organization Western Pacific Regional Medical Index (WPRIM) in 2009, and the Japan Science and Technology Agency Database (JST) and Scopus Database in 2018, and was included in the Wanfang Data-China Digital Journal Group and the China Academic Journal Comprehensive Evaluation Database.