先天性膈膨出：是否应继续手术治疗？一项回顾性多中心队列研究。

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2024-10-10 DOI:10.1016/j.jpedsurg.2024.161991

Lymeymey Heng , Khalid Alzahrani , Louise Montalva , Guillaume Podevin , Françoise Schmitt

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引用次数: 0

摘要

研究背景本研究旨在描述先天性膈肌连枷锁（CDE）患儿的特征，并比较法国小儿CDE手术治疗和保守治疗的结果：方法：对22个儿科外科部门的队列数据进行回顾性研究，包括2010年至2021年期间被诊断为CDE的16岁以下患者。结果：共纳入139名患者，平均年龄为16岁：共纳入 139 名患者，中位年龄为 8 [1-16] 个月。68.3%的 CDE 患者为男孩，66.7%的病例为右侧。治疗指征主要取决于呼吸道症状和膈穹的水平。87名患儿（62%）的初始治疗是通过手术进行膈肌成形术，52名患儿（38%）的初始治疗是保守治疗，包括临床随访。在后者中，有25名患儿接受了二次手术。32名患儿（29%）出现了术中和术后早期并发症，8名患儿（7%）复发。中位随访时间为28个月，膈肌穹隆的中位水平从第6根肋骨改善到了第9根肋骨，在所有患者中，呼吸道症状发生率从64%降至14%：结论：膈肌成形术对穹隆水平高于后第6根肋骨的有症状患者有效，但并发症发生率为29%，复发率为7%：临床试验：NCT04862494，2021年4月28日。证据级别：III级治疗研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Congenital Diaphragmatic Eventration: Should we Maintain Surgical Treatment? A Retrospective Multicentric Cohort Study

Background

The aims of this study were to describe the characteristics of children with congenital diaphragmatic eventration (CDE) and compare the outcomes of surgical and conservative treatment of pediatric CDE in France.

Methods

Retrospective study on cohort data conducted in 22 paediatric surgery departments, including patients less than 16 years of age diagnosed with CDE between 2010 and 2021. Patients with surgical or conservative treatment were compared.

Results

139 patients were included, with a median age of 8 [1–16] months. CDE occurred in boys in 68.3% and was right-sided in 66.7% of the cases. Indication for treatment depended essentially on respiratory symptoms and level of the diaphragmatic dome. The initial treatment was a surgical, with a diaphragmatic plication, in 87 cases (62%) and conservative, consisting of clinical follow-up in 52 children (38%). Of the latter, 25 children underwent surgery secondarily. Intra- and early post-operative complications occurred in 32 children (29%) and eventration recurrence in 8 children (7%). With a median follow-up of 28 months, the median level of diaphragmatic dome improved from the 6th to the 9th back rib, and the rate of respiratory symptoms decreased from 64% to 14% in the overall cohort of patients.

Conclusions

Diaphragmatic plication is effective in symptomatic patients with a dome level above the 6th posterior rib, but is associated with a 29% complication rate and 7% of recurrence.

ClinicalTrials

NCT04862494, April 28, 2021.

Level of evidence

level III treatment study.

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.