Neonatal thoracoscopic repair of congenital diaphragmatic hernias

Q4 Medicine
Lishuang Ma, Jingna Li, Simiao Yu, Chao Liu, Ying Wang, Dong-ying Qu, Yan-dong Wei, Yue Zhang, C. Feng, Yanxia Zhang
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引用次数: 0

Abstract

Objective To perform a retrospective analysis of neonates with congenital diaphragmatic hernia (CDH) and to summarize the dilemmas of thoracoscopic repairing. Methods From April 2014 to April 2019, a total of 27 CDH neonates underwent thoracoscopy. Due to an excellent visual field of pulmonary dysplasia, hernia viscera was sequentially returned into abdomen. Sharp instruments should not be directly compressed for restoring spleen along with stomach and colon. For severe defect of posterolateral diaphragm, suturing diaphragm margin-intercostal muscle-diaphragm margin and moderately tightening wire knot are employed for repairing diaphragm muscle and preventing recurrence. For severe diaphragmatic defect, continuous suture should be performed for closing defect as much as possible. And the size of weak defect was measured. Customized mesh was placed into chest cavity and fixed mesh tightly attached to weak diaphragm by interrupted suturing with 4-0 proline thread. Results The involved side was left (n=25) and right (n=2). Twenty-three cases were diagnosed prenatally. The average gestational age of prenatal diagnosis was (28.2±5.1) weeks, the average gestational age (37.5±2.7) weeks and the average birth weight (2.90±0.70) kg. Thoracoscopic repairs were successful (n=23) and converting into open operation (n=4). Among 23 survivors, the average operative age was (41±40) hours and the average operative duration (159±14) min. The average durations of ventilator supports and hospitalization were (5.1±1.2) and (18.0±4.0) days respectively. Three cases complicated with chylothorax were cured after conservative measures. There was one case of recurrence. However, based upon illness severity and operative duration, the prognoses of different groups showed no significant statistical differences. Conclusions Thoracoscopic repair is both safe and feasible for severe congenital diaphragmatic hernia in neonates. If a surgeon has extensive experiences, thoracoscopy may be selected as a first choice and completed successfully with patching. When cardiopulmonary functions are unstable and PaCO2 is continuously higher than (65-75) mmHg, thoracoscopy should be converted timely into open surgery. The thoracoscopic tolerance of low-weight premature infants is no less than that of full-term infants. Key words: Hernia, diaphragmatic; Neonate; Thoracoscopy
新生儿先天性膈疝的胸腔镜修复
目的对新生儿先天性膈疝(CDH)进行回顾性分析,总结胸腔镜下修补术的难点。方法2014年4月至2019年4月对27例CDH新生儿行胸腔镜检查。由于肺发育不良视野极佳,疝脏器依次返腹。修复脾、胃、结肠时,不要直接压迫尖锐的器械。对于严重的后外侧膈肌缺损,采用膈肌边缘-肋间肌-膈肌边缘缝合和钢丝结适度收紧的方法修复膈肌,防止复发。对于严重的膈肌缺损,应尽可能进行连续缝合以闭合缺损。并测量了弱缺陷的尺寸。将定制的补片置入胸腔内,用4-0脯氨酸线间断缝合,将补片紧贴在弱膈肌上。结果受累侧为左侧25例,右侧2例。23例经产前诊断。产前诊断平均胎龄为(28.2±5.1)周,平均胎龄为(37.5±2.7)周,平均出生体重为(2.90±0.70)kg。胸腔镜下修复成功(n=23),并转为开放手术(n=4)。23例存活患者平均手术年龄为(41±40)小时,平均手术时间为(159±14)分钟,平均呼吸机支持时间为(5.1±1.2)天,平均住院时间为(18.0±4.0)天。3例合并乳糜胸经保守治疗治愈。有一例复发。然而,基于疾病严重程度和手术时间,不同组的预后无显著统计学差异。结论胸腔镜下修补新生儿重度先天性膈疝是安全可行的。如果外科医生有丰富的经验,可以选择胸腔镜作为首选,并成功地完成补片。当心肺功能不稳定,PaCO2持续高于(65 ~ 75)mmHg时,应及时转开胸腔镜手术。低体重早产儿的胸腔镜耐受性不低于足月儿。关键词:疝;膈肌;新生儿;胸腔镜检查
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来源期刊
中华小儿外科杂志
中华小儿外科杂志 Medicine-Pediatrics, Perinatology and Child Health
CiteScore
0.40
自引率
0.00%
发文量
8707
期刊介绍: Chinese Journal of Pediatric Surgery is an academic journal sponsored by the Chinese Medical Association. It mainly publishes original research papers, reviews and comments in this field. The journal was founded in 1980 and is included in well-known databases such as Peking University Journal (Chinese Journal of Humanities and Social Sciences) and CSCD Chinese Science Citation Database Source Journal (including extended version). It is one of the national key academic journals under the supervision of the China Association for Science and Technology. Chinese Journal of Pediatric Surgery enjoys a high reputation and influence in the academic community. The articles published in this journal have a high academic level and practical value, providing readers with a large number of practical cases and industry information, and have received widespread attention and citations from readers.
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