Department of Paediatric Surgery, Great Ormond Street Hospital and the UCL Institute of Child Health, London WC1N 1EH, UK.
J Pediatr Surg. 2010 Feb;45(2):355-9. doi: 10.1016/j.jpedsurg.2009.10.072.
Thoracoscopic repair of congenital diaphragmatic hernia (CDH) has been described, but its efficacy and safety have not been validated. The aim was to compare our experience of thoracoscopy with laparotomy repair.
After ethics approval, we reviewed the notes of neonates with CDH operated in our institution between 2003 and 2008. Two historical groups were compared: infants who underwent laparotomy (2003-2008) or thoracoscopy (2007-2008). Data were compared by t test or Mann-Whitney tests.
Thirty-five children had open repair of CDH, and 13 had thoracoscopic repair. Groups were homogeneous for age and weight. Five (38%) neonates who had thoracoscopy were converted to open for surgical difficulties (n = 4) and O(2) desaturation (n = 1). Patch repair was used in 12 (34%) open and 6 (46%) thoracoscopic repairs. End-tidal CO(2) was significantly elevated during thoracoscopy, but this was not reflected in arterial CO(2) or pH. There were 3 (8%) recurrences after open repair and 2 (25%) after thoracoscopy (P = .19).
Thoracoscopic repair of CDH is feasible. Arterial blood gases should be closely monitored. Despite higher EtCO(2), conversion to open was mainly because of difficult repair. A randomized trial is necessary to assess the effect of thoracoscopy on ventilation and recurrences.
胸腔镜手术已被用于治疗先天性膈疝（CDH），但其疗效和安全性尚未得到验证。本研究旨在比较胸腔镜与开腹手术修复 CDH 的效果。
本研究经伦理委员会批准，回顾了我院 2003 年至 2008 年期间接受手术治疗的先天性膈疝新生儿的病历。比较了两组历史数据：2003-2008 年接受开腹手术的患儿（开腹组），2007-2008 年接受胸腔镜手术的患儿（胸腔镜组）。采用 t 检验或 Mann-Whitney 检验比较数据。
35 例患儿行开腹手术，13 例行胸腔镜手术。两组患儿在年龄和体重方面具有可比性。5 例（38%）胸腔镜手术患儿因手术困难（n = 4）和 O2 饱和度降低（n = 1）转为开腹手术。12 例（34%）开腹手术和 6 例（46%）胸腔镜手术采用补片修补。胸腔镜手术过程中呼气末二氧化碳分压显著升高，但动脉二氧化碳分压和 pH 无变化。开腹组 3 例（8%）复发，胸腔镜组 2 例（25%）复发（P =.19）。
胸腔镜治疗 CDH 是可行的。应密切监测动脉血气。尽管胸腔镜组呼气末二氧化碳分压较高，但转为开腹主要是因为手术困难。需要进行随机试验以评估胸腔镜对通气和复发的影响。
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