Fasching G, Huber A, Uray E, Sorantin E, Lindbichler F, Mayr J
Department of Pediatric Surgery, Preyer Children's Hospital, Vienna, Austria.
Eur J Pediatr Surg. 2000 Dec;10(6):360-4. doi: 10.1055/s-2008-1072391.
At the Department of Pediatric Surgery in Graz, 31 boys and 23 girls were operated on for congenital diaphragmatic hernia (CDH) from 1978 to 1994. In 49 patients the defect was on the left, in five on the right side. In 46 cases, the hernia was diagnosed within the first week of life; in eight children at a later date. 19 children (35%) died. 25 of the 35 survivors (71%) came to a follow-up examination on average 9.4 (1-17) years after the operation. 24 h pH-monitoring or manometry and Upper G.I. series revealed pathological gastroesophageal reflux (GER) in 16 patients. Nine children were treated conservatively; in seven patients an antireflux procedure was performed. A thoracic position of the stomach or left liver lobe, presence of a hernial sac, gestational age, prenatal diagnosis, use of a patch or severity of lung hypoplasia did not significantly influence the incidence of GER. In three patients, a hiatal hernia was found. The motility of the diaphragm was documented with M-mode sonography (n = 18); a restricted motility could be demonstrated in five patients. GER is very common in patients after repair of CDH. We recommend long-term follow-up with special interest in respect of GER.
1978年至1994年期间，格拉茨小儿外科为31名男孩和23名女孩实施了先天性膈疝（CDH）手术。49例患者的缺损在左侧，5例在右侧。46例在出生后第一周内确诊为膈疝；8例患儿确诊时间较晚。19名患儿（35%）死亡。35名幸存者中的25名（71%）在术后平均9.4（1 - 17）年接受了随访检查。24小时pH监测或测压以及上消化道造影显示16例患者存在病理性胃食管反流（GER）。9名患儿接受了保守治疗；7例患者接受了抗反流手术。胃或左肝叶的胸腔内位置、疝囊的存在、胎龄、产前诊断、补片的使用或肺发育不全的严重程度对GER的发生率没有显著影响。3例患者发现有食管裂孔疝。通过M型超声检查记录了18例患者的膈肌活动情况；5例患者显示膈肌活动受限。GER在CDH修复术后的患者中非常常见。我们建议进行长期随访，并特别关注GER。
