{"title":"新生儿先天性膈疝的胸腔镜修复","authors":"Lishuang Ma, Jingna Li, Simiao Yu, Chao Liu, Ying Wang, Dong-ying Qu, Yan-dong Wei, Yue Zhang, C. Feng, Yanxia Zhang","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.01.005","DOIUrl":null,"url":null,"abstract":"Objective \nTo perform a retrospective analysis of neonates with congenital diaphragmatic hernia (CDH) and to summarize the dilemmas of thoracoscopic repairing. \n \n \nMethods \nFrom 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. \n \n \nResults \nThe 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. \n \n \nConclusions \nThoracoscopic 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. \n \n \nKey words: \nHernia, diaphragmatic; Neonate; Thoracoscopy","PeriodicalId":10157,"journal":{"name":"中华小儿外科杂志","volume":"1 1","pages":"23-28"},"PeriodicalIF":0.0000,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Neonatal thoracoscopic repair of congenital diaphragmatic hernias\",\"authors\":\"Lishuang Ma, Jingna Li, Simiao Yu, Chao Liu, Ying Wang, Dong-ying Qu, Yan-dong Wei, Yue Zhang, C. Feng, Yanxia Zhang\",\"doi\":\"10.3760/CMA.J.ISSN.0253-3006.2020.01.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Objective \\nTo perform a retrospective analysis of neonates with congenital diaphragmatic hernia (CDH) and to summarize the dilemmas of thoracoscopic repairing. \\n \\n \\nMethods \\nFrom 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. \\n \\n \\nResults \\nThe 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. \\n \\n \\nConclusions \\nThoracoscopic 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. \\n \\n \\nKey words: \\nHernia, diaphragmatic; Neonate; Thoracoscopy\",\"PeriodicalId\":10157,\"journal\":{\"name\":\"中华小儿外科杂志\",\"volume\":\"1 1\",\"pages\":\"23-28\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2020-01-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"中华小儿外科杂志\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.01.005\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"中华小儿外科杂志","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.01.005","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
Neonatal thoracoscopic repair of congenital diaphragmatic hernias
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
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.