Shah Sohail R, Wishnew Jessica, Barsness Katherine, Gaines Barbara A, Potoka Douglas A, Gittes George K, Kane Timothy D
Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, 3705 Fifth Avenue, 4A-485, Pittsburgh, PA 15213, USA.
Surg Endosc. 2009 Jun;23(6):1265-71. doi: 10.1007/s00464-008-0143-2. Epub 2008 Oct 2.
Minimally invasive surgery (MIS) has been described for the repair of congenital diaphragmatic hernias (CDH) in neonates, infants, and children. This report evaluates patient selection, operative technique, and clinical outcomes for MIS repair of CDHs from a single center's experience.
All cases of CDH at a tertiary care pediatric hospital with an initial attempt at MIS repair from January 2001 to December 2007 were reviewed.
A total of 22 children underwent an initial attempt at MIS repair of their CDH (5 Morgagni and 17 Bochdalek hernias). The children ranged in age from 1 day to 6 years (mean, 13.9 +/- 23 months) and weighed 2.2 to 21 kg (mean, 7.4 +/- 5.50 kg) at the time of the operation. All five Morgagni hernias were managed successfully with laparoscopic primary repair. Six of the Bochdalek hernias were found in infants and children (age range, 6-71 months). All these were managed successfully with primary repair by an MIS approach (2 by laparoscopy and 4 by thoracoscopy). The remaining 11 Bochdalek hernias were found in neonates (age range, 1 day to 8 weeks). Four of the Bochdalek hernias were right-sided. Nine of the Bochdalek hernias in neonates were repaired thoracoscopically. One neonate required conversion to laparotomy, and another underwent conversion to thoracotomy. Four of the neonates with Bochdalek hernias required a prosthetic patch. Two of the neonates also had significant associated congenital cardiac defects. Overall, there were two recurrences involving one 3-day-old who underwent a primary thoracoscopic repair and another 3-day-old who underwent a thoracoscopic patch repair. The follow-up period ranged from 5 months to 5 years.
Morgagni hernias can be managed successfully by laparoscopy, whereas thoracoscopy is preferred for neonatal Bochdalek hernias. Either approach can be successful for infants and children with Bochdalek hernias. Additionally, patients with congenital cardiac defects and those requiring prosthetic patches can undergo a MIS CDH repair with a successful outcome.
微创外科手术（MIS）已被用于新生儿、婴儿和儿童先天性膈疝（CDH）的修复。本报告根据单一中心的经验评估了MIS修复CDH的患者选择、手术技术和临床结果。
回顾了一家三级儿科医院2001年1月至2007年12月首次尝试MIS修复的所有CDH病例。
共有22名儿童首次尝试MIS修复其CDH（5例Morgagni疝和17例Bochdalek疝）。这些儿童年龄从1天至6岁（平均13.9±23个月），手术时体重2.2至21千克（平均7.4±5.50千克）。所有5例Morgagni疝均通过腹腔镜一期修复成功处理。6例Bochdalek疝见于婴儿和儿童（年龄范围6至71个月）。所有这些均通过MIS方法一期修复成功（2例通过腹腔镜，4例通过胸腔镜）。其余11例Bochdalek疝见于新生儿（年龄范围1天至8周）。4例Bochdalek疝为右侧。9例新生儿Bochdalek疝通过胸腔镜修复。1例新生儿需要转为开腹手术，另1例需要转为开胸手术。4例患有Bochdalek疝的新生儿需要使用人工补片。2例新生儿还伴有严重的先天性心脏缺陷。总体而言，有2例复发，1例为3日龄接受初次胸腔镜修复的患儿，另1例为3日龄接受胸腔镜补片修复的患儿。随访期为5个月至5年。
Morgagni疝可通过腹腔镜成功处理，而胸腔镜是新生儿Bochdalek疝的首选方法。对于患有Bochdalek疝的婴儿和儿童，两种方法均可成功。此外，患有先天性心脏缺陷的患者和需要人工补片的患者可以接受MIS CDH修复并取得成功结果。
