两阶段修复术能否解决需要体外膜氧合的严重先天性膈疝的修复时机难题?

IF 2 4区 医学 Q2 PEDIATRICS
Akiko Yokoi
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引用次数: 0

摘要

审查目的:先天性膈疝(CDH)仍然是一项重大挑战,尤其是对于伴有持续性肺动脉高压(PPHN)、肺部和心脏发育不良的严重病例。对于常规疗法无效的患者,需要进行 ECMO。虽然手术修复相对简单,但确定需要 ECMO 患者的最佳手术时机尤其具有挑战性。这篇综述探讨了手术时机的两难选择,并提出了一种分两个阶段的方法:在启动 ECMO 之前,缩小疝出器官并创建一个筒仓以减轻腹压,然后在 ECMO 解除封管后关闭缺损:最近的研究结果:研究支持 ECMO 前、ECMO 中和 ECMO 后修复,每种方法都有各自的风险和益处。ECMO 前修复可缓解器官压迫,从而提高 ECMO 的疗效,但会因不稳定性而带来风险。ECMO 后修复更为安全,但可能导致失去修复机会。在 ECMO 上进行修复有很大的出血风险,但目前建议在早期修复的同时进行谨慎的抗凝管理。最近,作者报告了一例采用两阶段方法的成功病例--在 ECMO 之前减少疝出器官并创建一个筒仓,然后在 ECMO 解除封管后进行缺损闭合--这为处理严重 CDH 提出了一种潜在的替代策略。摘要:两阶段方法可为需要 ECMO 的严重 CDH 患者提供一种解决方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Could a Two-Staged Repair Be the Solution to the Dilemma of Repair Timing for Severe Congenital Diaphragmatic Hernia Requiring Extracorporeal Membrane Oxygenation?

Purpose of review: Congenital diaphragmatic hernia (CDH) remains a significant challenge, particularly in severe cases with persistent pulmonary hypertension (PPHN) and hypoplastic lungs and heart. For patients unresponsive to conventional therapies, ECMO is required. While the surgical repair is relatively simple, determining the optimal timing for surgery in patients requiring ECMO is particularly challenging. This review explores the dilemma of surgical timing and proposes a two-staged approach: a reduction in herniated organs and the creation of a silo to relieve abdominal pressure before initiating ECMO, with defect closure following ECMO decannulation.

Recent findings: Studies support pre-, on-, and post-ECMO repair, each with its own risks and benefits. Pre-ECMO repair may enhance ECMO efficacy by relieving organ compression but poses risks due to instability. Post-ECMO repair is safer but may result in losing the chance to repair. On-ECMO repair has significant hemorrhage risks, but early repair with careful anticoagulation management is currently recommended. Recently, the author reported a successful case using a two-staged approach-reducing herniated organs and creating a silo before ECMO, followed by defect closure after ECMO decannulation-which suggests a potential alternative strategy for managing severe CDH.

Summary: A two-staged approach may offer a solution for severe CDH patients requiring ECMO.

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来源期刊
Children-Basel
Children-Basel PEDIATRICS-
CiteScore
2.70
自引率
16.70%
发文量
1735
审稿时长
6 weeks
期刊介绍: Children is an international, open access journal dedicated to a streamlined, yet scientifically rigorous, dissemination of peer-reviewed science related to childhood health and disease in developed and developing countries. The publication focuses on sharing clinical, epidemiological and translational science relevant to children’s health. Moreover, the primary goals of the publication are to highlight under‑represented pediatric disciplines, to emphasize interdisciplinary research and to disseminate advances in knowledge in global child health. In addition to original research, the journal publishes expert editorials and commentaries, clinical case reports, and insightful communications reflecting the latest developments in pediatric medicine. By publishing meritorious articles as soon as the editorial review process is completed, rather than at predefined intervals, Children also permits rapid open access sharing of new information, allowing us to reach the broadest audience in the most expedient fashion.
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