Please wait a minute...
浙江大学学报（医学版）
浙江大学学报（医学版）  2018, Vol. 47 Issue (3): 283-288    DOI: 10.3785/j.issn.1008-9292.2018.06.11
专题报道     
胸腔镜手术治疗新生儿先天性膈疝47例
王合锋1(),刘兴峰2,王洪轩1,胡元军1,武玉睿3,*()
1. 山东大学齐鲁儿童医院新生儿外科, 山东 济南 250022
2. 山东大学齐鲁医院新生儿重症监护室, 山东 济南 250012
3. 山东大学齐鲁儿童医院胸外肿瘤外科(微创外科), 山东 济南 250022
Thoracoscopic repair of congenital diaphragmatic hernia in neonates: a report of 47 cases
WANG Hefeng1(),LIU Xingfeng2,WANG Hongxuan1,HU Yuanjun1,WU Yurui3,*()
1. Department of Neonate Surgery, Qilu Children's Hospital of Shandong University, Jinan 250022, China
2. Neonatal Intensive Care Unit, Qilu Hospital of Shandong University, Jinan 250012, China
3. Department of Thoracic and Oncological Surgery, Qilu Children's Hospital of Shandong University, Jinan 250022, China
 全文: PDF(3810 KB)   HTML( 7 )
摘要：

目的: 总结胸腔镜手术治疗新生儿先天性膈疝的围手术期处理经验，以期提高先天性膈疝患儿的治愈率。方法: 回顾性分析2012年6月至2017年6月山东大学齐鲁儿童医院收治的47例接受胸腔镜手术治疗先天性膈疝患儿的临床资料。分析先天性膈疝患儿的入院年龄、胎龄、出生体质量、是否有产前诊断、膈疝位置、临床表现、手术时机、手术方式、手术时间、术后机械通气时间等资料。结果: 47例患儿中，左侧膈疝42例，右侧膈疝5例，产前检查发现先天性膈疝13例。45例患儿顺利完成胸腔镜手术，手术时间为42~150 min，平均为（63±13）min；术中出血量为1.0~9.0 mL，平均为（3.0±1.7）mL；术后需呼吸机支持天数为2.0~11.0 d，平均为（3.9±1.4）d。2例患儿中转开放手术。47例患儿中，术后死亡2例，放弃治疗3例，其余患儿均治愈出院，治愈率为89.4%（42/47）。结论: 胸腔镜手术治疗新生儿膈疝疗效确切，可以作为治疗新生儿膈疝的首选方式。
关键词： 胸腔镜检查;  疝, 横膈/外科学;  疝, 横膈/先天性;  婴儿, 新生    
Abstract:

Objective: To review the application of thoracoscopic repair for treatment of congenital diaphragmatic hernia in neonates, so as to improve the cure rate. Methods: Clinical data of 47 neonates with congenital diaphragmatic hernia receiving thoracoscopic repair from June 2012 to June 2017 were reviewed. The admission age, gestational age, birth weight, timing of diagnosis, hernia location, clinical manifestation, surgical timing, surgical method, operation time, postoperative mechanical ventilation time of patients were analyzed. Results: There were 42 cases of left diaphragmatic hernia and 5 cases of right diaphragmatic hernia. Thirteen cases were diagnosed prenatally. Primary diaphragmatic repair was successfully accomplished under thoracoscope in 45 neonates without perioperative complications, while 2 patients were converted to open surgery. The average operation time was (63±13) min (42-150 min), the average blood loss was (3.0±1.7) mL (1.0-9.0 mL), and the average postoperative mechanical ventilation time was (3.9±1.4) d (2.0-11.0 d). Two patients died and the treatment was withdrawn in 3 patients with an overall cure rate of 89.4% (42/47). Conclusion: Thoracoscopic repair is effective and can be used as first-choice treatment of diaphragmatic hernia in neonates.
Key words: Thoracoscopy    Hernia, diaphragmatic/surgery    Hernia, diaphragmatic/congenital    Infant, newborn
收稿日期: 2018-03-28 出版日期: 2018-09-18
CLC:  R655  
通讯作者: 武玉睿     E-mail: whf-139@163.com;wuyrr@163.com
作者简介: 王合锋(1980-), 男, 博士, 主治医师, 主要从事小儿普外及新生儿外科的临床工作; E-mail:whf-139@163.com; https://orcid.org/0000-0002-7351-7567
服务　　
把本文推荐给朋友
加入引用管理器
E-mail Alert
RSS
作者相关文章　　
王合锋
刘兴峰
王洪轩
胡元军
武玉睿

引用本文:

王合锋,刘兴峰,王洪轩,胡元军,武玉睿. 胸腔镜手术治疗新生儿先天性膈疝47例[J]. 浙江大学学报（医学版）, 2018, 47(3): 283-288.

WANG Hefeng,LIU Xingfeng,WANG Hongxuan,HU Yuanjun,WU Yurui. Thoracoscopic repair of congenital diaphragmatic hernia in neonates: a report of 47 cases. J Zhejiang Univ (Med Sci), 2018, 47(3): 283-288.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2018.06.11    或    http://www.zjujournals.com/med/CN/Y2018/V47/I3/283

图 1  先天性膈疝患儿胸部X射线检查图像
图 2  先天性膈疝患儿胸腔镜手术体位及切口位置
图 3  一例右侧严重膈疝患儿胸腔镜和开胸手术术中所见
图 4  一例左侧膈疝患儿胸腔镜和开腹手术术中所见
1 刘文英, 吉毅 . 先天性膈疝的研究与诊治进展[J]. 中华小儿外科杂志, 2011, 32 (4): 302- 305
LIU Wenying , JI Yi . Progress on the research and treatment of congenital diaphragmatic hernia[J]. Chinese Journal of Pediatric Surgery, 2011, 32 (4): 302- 305
doi: 10.3760/cma.j.issn.0253-3006.2011.04.017
2 张金哲 . 张金哲小儿外科学[M]. 北京: 人民卫生出版社, 2013: 763- 773
ZHANG Jinzhe . Zhang Jinzhe pediatric surgery[M]. Beijing: People's Medical Publishing House, 2013: 763- 773
3 LEEUWEN L , FITZGERALD D A . Congenital diaphragmatic hernia[J]. Pediatr Child Health, 2014, 50 (9): 667- 673
doi: 10.1111/jpc.2014.50.issue-9
4 冯晋兴 . 新生儿先天性膈疝死亡危险因素分析[J]. 中国小儿急救医学, 2014, 21 (6): 373- 376
FENG Jinxing . Risk factors associated with death of newborn with congenital diaphragmatic hernia[J]. Chinese Pediatric Emergency Medicine, 2014, 21 (6): 373- 376
doi: 10.3760/cma.j.issn.1673-4912.2014.06.010
5 曾朝夕, 解丽梅 . 超声预测胎儿先天性膈疝预后的研究进展[J]. 中国临床医学影像杂志, 2017, 27 (7): 516- 518
ZENG Zhaoxi , XIE Limei . Progress of ultrasound in predicting prognosis of congenital diaphragm hernia[J]. Journal of China Clinic Medical Imaging, 2017, 27 (7): 516- 518
doi: 10.3969/j.issn.1008-1062.2017.07.015
6 夏波, 俞刚, 洪淳 et al. 胎儿中重度膈疝的产前诊断和生后治疗一体化管理模式[J]. 中华围产医学杂志, 2015, 18 (11): 843- 847
XIA Bo , YU Gang , HONG Chun et al. Integrated prenatal diagnosis and postnatal treatment for moderate and severe congenital diaphragmatic hernia[J]. Chinese Journal of Perinatal Medicine, 2015, 18 (11): 843- 847
doi: 10.3760/cma.j.issn.1007-9408.2015.11.011
7 钟微 . 先天性膈疝的诊疗进展[J]. 中华实用儿科临床杂志, 2013, 28 (23): 1769- 1771
ZHONG Wei . Diagnosis and treatment of congenital diaphragmatic hernia[J]. Journal of Applied Clinical Peditrics, 2013, 28 (23): 1769- 1771
doi: 10.3760/cma.j.issn.2095-428X.2013.23.005
8 REISS I , SCHAIBLE T , VAN DEN HOUT L et al. Standardized postnatal management of infants with congenital diaphragmatic hernia in Europe:the CDH EURO Consortium consensus[J]. Neonatology, 2010, 98 (4): 354- 364
doi: 10.1159/000320622
9 CHOU H C , HSU W M . New evolutions in congenital diaphragmatic hernia[J]. Pediatr Neonatol, 2010, 51 (2): 80- 82
doi: 10.1016/S1875-9572(10)60015-0
10 马丽霜, 李龙 . 腔镜手术与开放手术治疗新生儿膈疝的对比研究[J]. 中华小儿外科杂志, 2014, 35 (8): 599- 602
MA Lishuang , LI Long . A comparison of clinical outcome of neonatal diaphragmatic hernia between minimally invasive surgery and open repair[J]. Chinese Journal of Pediatric Surgery, 2014, 35 (8): 599- 602
doi: 10.3760/cma.j.issn.0253-3006.2014.08.010
11 张智恩, 郑珊, 董瑞 et al. 新生儿先天性膈疝诊治及预后相关因素分析——单中心近10年经验总结[J]. 临床小儿外科杂志, 2017, 16 (1): 31- 36
ZHANG Zhi'en , ZHENG Shan , DONG Rui et al. Diagnosis, treatment and prognosis of neonatal congenital diaphragmatic hernia:a single center 10-year experience[J]. Journal of Clinical Pediatric Surgery, 2017, 16 (1): 31- 36
12 何秋明, 钟微, 李乐 . 标准化指征下胸腔镜手术治疗新生儿先天性膈疝[J]. 中国微创外科杂志, 2015, 15 (8): 707- 710
HE Qiuming , ZHONG Wei , LI Le et al. Outcomes of thoracoscopic repair of congenital diaphragmatic hernia in neonates under standardized indications[J]. Chinese Journal of Minimally Invasive Surgery, 2015, 15 (8): 707- 710
doi: 10.3969/j.issn.1009-6604.2015.08.011
13 吴鑫铭, 沈淳, 黄焱磊 et al. 胸腔镜手术治疗新生儿膈疝的临床研究[J]. 临床小儿外科杂志, 2013, 12 (4): 267- 270
WU Xinming , SHEN Chun , HUANG Yanlei et al. A comparison of clinical outcome of neonatal diaphragmatic hernia between thoracoscopic repair and laparotomy[J]. Journal of Clinical Pediatric Surgery, 2013, 12 (4): 267- 270
14 JANCELEWICZ T , LANGER J C , CHIANG M et al. Thoracoscopic repair of neonatal congenital diaphragmatic hernia (CDH):outcomes after a systematic quality improvement process[J]. J Pediatr Surg, 2013, 48 (2): 321- 325
doi: 10.1016/j.jpedsurg.2012.11.012
15 INOUE M , UCHIDA K , OTAKE K et al. Thoracoscopic repair of congenital diaphragmatic hernia with countermeasures against reported complications for safe outcomes comparable to laparotomy[J]. Surg Endosc, 2016, 30 (3): 1014- 1019
doi: 10.1007/s00464-015-4287-6
16 ATKINSON J B , POON M W . ECMO and the management of congenital diaphragmatic hernia with large diaphragmatic defects requiring a prosthetic patch[J]. J Pediatr Surg, 1992, 27 (6): 754- 756
doi: 10.1016/S0022-3468(05)80109-5
17 MOSS R L , CHEN C M , HARRISONM R . Prosthetic patch durability in congenital diaphragmatic hernia:a long-term follow-up study[J]. J Pediatr Surg, 2001, 36 (1): 152- 154
doi: 10.1053/jpsu.2001.20037
18 ST PETER S D , VALUSEK P A , TSAO K et al. Abdominal complications related to type of repair for congenital diaphragmatic hernia[J]. J Surg Res, 2007, 140 (2): 234- 236
doi: 10.1016/j.jss.2007.03.018
19 黄金狮, 陈快, 戴康临 et al. 经胸腔镜手术治疗先天性膈疝的体会[J]. 中华小儿外科杂志, 2012, 33 (5): 340- 343
HUANG Jinshi , CHEN Kuai , DAI Kanglin et al. Thoracoscopic repair of congenital diaphragmatic herniain neonates and infants[J]. Chinese Journal of Pediatric Surgery, 2012, 33 (5): 340- 343
doi: 10.3760/cma.j.issn.0253-3006.2012.05.006
20 吴晔明 . 腔镜下新生儿膈疝修补术[J]. 临床小儿外科杂志, 2017, 16 (1): 15- 17
WU Yeming . Endoscopic repair surgery for congenital diaphragmatic hernia in neonates[J]. Journal of Clinical Pediatric Surgery, 2017, 16 (1): 15- 17
[1] 张玉喜,莫绪明,孙剑,彭卫,戚继荣,武开宏,束亚琴. 胸腔镜手术治疗Ⅲ型食管闭锁合并气管食管瘘新生儿的疗效[J]. 浙江大学学报（医学版）, 2018, 47(3): 266-271.
[2] 黄婷,张晓乐,梁靓,谭征,高跃,李建华,舒强. 腔镜手术治疗肺隔离症患儿47例[J]. 浙江大学学报（医学版）, 2018, 47(3): 272-277.