Arca Marjorie J, Barnhart Douglas C, Lelli Joseph L, Greenfeld Jonathon, Harmon Carroll M, Hirschl Ronald B, Teitelbaum Daniel H
Department of Surgery, University of Michigan Medical School and the C.S. Mott Children's Hospital, Ann Arbor, MI 53226, USA.
J Pediatr Surg. 2003 Nov;38(11):1563-8. doi: 10.1016/s0022-3468(03)00564-5.
Minimally invasive surgery (MIS) for the repair of congenital diaphragmatic hernias (CDH) had been described. This report reviews the authors' experience with MIS repairs of CDH and discusses the technical development of this approach.
From 1999 until now, the authors collected data on children who underwent an MIS approach for CDH repair.
Seventeen children (11 Morgagni and 7 Bochdalek) had undergone an attempt at MIS repair. All Morgagni defects were treated successfully using laparoscopy (mean age, 28 +/- 31 months). Mean follow-up was 22 +/- 9 months. There was 1 recurrence. Four children with Bochdalek CDH were treated as newborns (range, 3 to 21 days), and 3 had operations later (4, 11, and 32 months). The first repair was attempted initially transabdominally and was converted to a thoracoscopic approach. The rest of the Bochdalek repairs were performed thoracoscopically. Bochdalek repairs via MIS were successful in 3 children (2 older children and 1 neonate). No child had pulmonary hypertension. Two of the 3 Bochdalek patients did well postoperatively (follow-up, 18 +/- 7 months); the last patient experienced recurrence 11 months after repair.
MIS for CDH is ideal for Morgagni defects. It should be considered for nonnewborns with a Bochdalek CDH. The MIS approach for a newborn with a CDH cannot be recommended because of the high failure rate and frequent rise in PCO2 levels.
已有关于先天性膈疝（CDH）修复的微创手术（MIS）的报道。本报告回顾了作者进行CDH微创手术修复的经验，并讨论了该方法的技术发展。
从1999年至今，作者收集了接受CDH修复微创手术的儿童的数据。
17名儿童（11例莫尔加尼疝和7例博赫dalek疝）尝试进行了MIS修复。所有莫尔加尼缺损均通过腹腔镜成功治疗（平均年龄28±31个月）。平均随访时间为22±9个月。有1例复发。4例博赫dalek CDH患儿作为新生儿接受治疗（年龄范围3至21天），3例后来接受手术（4、11和32个月）。首次修复最初尝试经腹进行，后改为胸腔镜手术。其余博赫dalek疝修复采用胸腔镜进行。通过MIS进行的博赫dalek疝修复在3名儿童（2名大龄儿童和1名新生儿）中成功。没有儿童患有肺动脉高压。3例博赫dalek疝患者中有2例术后情况良好（随访18±7个月）；最后1例患者在修复后11个月复发。
MIS修复CDH对于莫尔加尼缺损是理想的。对于非新生儿博赫dalek CDH应考虑采用该方法。由于失败率高和PCO2水平频繁升高，不建议对患有CDH的新生儿采用MIS方法。
