Department of Pediatric Surgery, Universitätsklinikum Mannheim, University of Heidelberg, Mannheim 68167, Germany.
J Pediatr Surg. 2011 Aug;46(8):1510-5. doi: 10.1016/j.jpedsurg.2011.03.085.
Congenital diaphragmatic hernia (CDH) is known to be a predisposing factor in gastroesophageal reflux (GER) leading to pulmonary and nutritional problems. The aim of this prospective, randomized, patient-blinded study was to evaluate the benefit of antireflux surgery at the time of CDH repair.
From 2003 to 2009, 79 neonates with left-sided CDH were included. Forty-three had regular hernia closure. Thirty-six patients additionally had fundoplication at hernia repair. Follow-up was at 6, 12, and 24 months after birth with a standardized questionnaire and a thorax radiograph. Patients with clinical signs for GER were evaluated with upper gastrointestinal series and 24-hour pH-metry.
Seventy-nine of 263 patients participated in this prospective trial. Survival rate was 88.61%. The GER symptoms were almost significantly more frequent in the group without concomitant fundoplication at the age of 6 months. At 24 months, the difference between both groups was not significant anymore. Development of body weight in the first 2 years of life was similar in both groups. No complications related to initial antireflux surgery were noted.
Patients profit from fundoplication at CDH repair only within the first year of life. At the present point of this study, simultaneous fundoplication at the time of primary CDH repair cannot be recommended as a standard procedure in all patients with left-sided CDH.
先天性膈疝（CDH）已知是胃食管反流（GER）的一个诱发因素，导致肺部和营养问题。本前瞻性、随机、患者盲法研究的目的是评估在 CDH 修复时进行抗反流手术的益处。
2003 年至 2009 年，共纳入 79 例左侧 CDH 新生儿。43 例行常规疝修补术。36 例患者在疝修补时另外行胃底折叠术。在出生后 6、12 和 24 个月时，通过标准化问卷和胸部 X 线片进行随访。有 GER 临床症状的患者通过上消化道系列检查和 24 小时 pH 监测进行评估。
263 例患者中有 79 例参加了这项前瞻性试验。存活率为 88.61%。在 6 个月大时，没有同时进行胃底折叠术的组中，GER 症状更为频繁，几乎具有统计学意义。在 24 个月时，两组之间的差异不再具有统计学意义。两组在前 2 年的体重发育相似。没有发现与初始抗反流手术相关的并发症。
患者仅在 CDH 修复后的第一年受益于胃底折叠术。在本研究的现阶段，不能推荐在所有左侧 CDH 患者中，将同时进行胃底折叠术作为一种标准手术。
