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先天性膈疝的胸腔镜修补术:45例经验教训

Thoracoscopic repair for congenital diaphragmatic hernia: lessons from 45 cases.

作者信息

Nguyen Thanh Liem, Le Anh Dung

机构信息

Department of Surgery, National Hospital of Pediatrics, Hanoi, Vietnam.

出版信息

J Pediatr Surg. 2006 Oct;41(10):1713-5. doi: 10.1016/j.jpedsurg.2006.05.043.

Abstract

PURPOSE

To describe the surgical technique, initial results, and overview indications of thoracoscopic repair of congenital diaphragmatic hernia (CDH).

MATERIALS AND METHODS

A retrospective review was undertaken of patients with CDH who underwent thoracoscopic repair by the same surgeon from January 2001 to January 2005. Patients underwent surgery under general anesthesia. Reduction of the hernia contents was carried out using 1 optical trocar and 2 operating trocars. Pleural insufflation with carbon dioxide was maintained at a pressure of 2 to 4 mm Hg. The hernia defect was repaired using nonabsorbable interrupted sutures with extracorporeal knots.

RESULTS

There were 45 patients, including 29 boys and 16 girls. Among 19 newborn patients, there were 13 patients younger than 7 days. The other 26 patients were infants and elders. The hernia was located in the left side in 37 patients and in the right side in 8 patients. The mean operative time was 54 minutes. Conversion was required in 4 patients. There were no complications. However, there were 2 postoperative deaths.

CONCLUSIONS

Thoracoscopic repair is feasible and safe for children with CDH, including selective newborn. The technique causes minimal trauma, results in good respiratory function, and promotes early recovery.

摘要

目的

描述先天性膈疝(CDH)胸腔镜修复术的手术技术、初步结果及总体适应症。

材料与方法

对2001年1月至2005年1月间由同一位外科医生进行胸腔镜修复术的CDH患者进行回顾性研究。患者在全身麻醉下接受手术。使用1个光学套管针和2个操作套管针将疝内容物回纳。二氧化碳胸膜腔充气压力维持在2至4毫米汞柱。使用带体外结的不可吸收间断缝线修复疝缺损。

结果

共45例患者,其中男29例,女16例。19例新生儿患者中,13例年龄小于7天。其他26例患者为婴儿和年长儿。疝位于左侧37例,右侧8例。平均手术时间为54分钟。4例患者需要中转开胸。无并发症发生。然而,有2例术后死亡。

结论

胸腔镜修复术对于CDH患儿,包括部分选择性新生儿是可行且安全的。该技术创伤极小,呼吸功能良好,促进早期恢复。

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