Szavay Philipp O, Obermayr Florian, Maas Christoph, Luenig Holger, Blumenstock Gunnar, Fuchs Joerg
Department of Pediatric Surgery, University Children's Hospital, Tuebingen, Germany.
J Laparoendosc Adv Surg Tech A. 2012 Apr;22(3):285-9. doi: 10.1089/lap.2011.0356. Epub 2012 Feb 22.
The aim of this study was to evaluate outcome of patients with congenital diaphragmatic hernia (CDH) undergoing open versus minimally invasive surgery.
Patient records of 33 children undergoing surgery for CDH between March 2002 and September 2008 were reviewed. Patient data were compared regarding operating time, intraoperative maximum CO(2) partial pressure (pCO(2 max)) values, postoperative ventilation time, complications, and recurrences.
Median age at time of operation was 4 days (range, 0-1017 days), and median weight was 3800 g (range, 2000-13,200 g). Laparotomy was performed in 12 children. Seventeen patients underwent thoracoscopic repair, and four children had a laparoscopic approach. Operating time was significantly longer (P=.004) in the minimally invasive group. Median values of pCO(2 max) during operation were not significantly different (P=.25) in the minimally invasive surgery group. The pCO(2 max) values in the postoperative course were significantly lower (P=.013) in the minimally invasive group, whereas median ventilation times postoperatively were significantly longer (P=.024) in the open surgery group.
Median values of pCO(2 max) in the postoperative course were significantly lower in the minimally invasive surgery group. In addition, postoperative ventilation time was shorter when children underwent minimally invasive surgery. In conclusion, minimally invasive surgery seems to offer advantages for selected patients with CDH.
本研究旨在评估接受开放手术与微创手术的先天性膈疝（CDH）患者的治疗结果。
回顾了2002年3月至2008年9月期间33例接受CDH手术的儿童患者记录。比较了患者在手术时间、术中最大二氧化碳分压（pCO₂max）值、术后通气时间、并发症和复发情况等方面的数据。
手术时的中位年龄为4天（范围0 - 1017天），中位体重为3800克（范围2000 - 13200克）。12例儿童接受了剖腹手术。17例患者接受了胸腔镜修复，4例儿童采用了腹腔镜手术方式。微创手术组的手术时间明显更长（P = 0.004）。微创手术组术中pCO₂max的中位值无显著差异（P = 0.25）。微创手术组术后病程中的pCO₂max值明显更低（P = 0.013），而开放手术组术后的中位通气时间明显更长（P = 0.024）。
微创手术组术后病程中pCO₂max的中位值明显更低。此外，儿童接受微创手术时术后通气时间更短。总之，微创手术似乎为部分CDH患者带来了优势。
