Rygl M, Kuklova P, Zemkova D, Slaby K, Pycha K, Stranak Z, Melichar J, Snajdauf J
Department of Pediatric Surgery, Second Faculty of Medicine and Teaching Hospital in Motol, Charles University in Prague, V úvalu 84, 15006, Prague 5, Czech Republic.
Pediatr Surg Int. 2012 Oct;28(10):971-6. doi: 10.1007/s00383-012-3113-7. Epub 2012 Jul 3.
The aim of our study is to introduce a new objective method of perioperative evaluation of the size of diaphragmatic defect to enable comparison of results among various centres and methods used for diaphragmatic reconstruction.
Prospective observational study of neonates with congenital diaphragmatic hernia (CDH) and respiratory distress within 24 h of birth operated on from January 2009 to December 2011. Weight, length, thoracic shape and the diameters of diaphragmatic defect were measured. To determine the relative size of the defect, a defect-diaphragmatic ratio (DDR = defect area:diaphragm area × 100) was calculated. The measured and calculated data were subsequently compared between Gore-Tex patch group (GT) and primary repair group (PR). Mann-Whitney U test was used for statistical analysis.
Forty-seven patients with CDH were admitted during study period. The overall survival rate was 79 % (37/47). Preoperative stabilization was achieved in 85 % (40/47). Survival of operated neonates was 93 % (37/40). Diaphragmatic reconstruction with Gore-Tex patch was used in 7 neonates (17 %), and primary repair in 33 (83 %). Mortality in Gore-Tex group was 29 %; mortality in primary repair group was 3 %. Data of anthropometric measurement were complete in 34 children (5 GT and 29 PR). Significant differences were found between GT group and PR group in the size of diaphragmatic defect with the transverse and sagittal diameters of defect (48.0 ± 5.7 vs. 30.1 ± 5.9, P < 0.00061; 34.0 ± 12.5 vs. 16.0 ± 7.3, P < 0.0022) and DDR (18.29 ± 4.60 vs. 5.77 ± 3.28, P < 0.0005), respectively.
The value of DDR as an objective criterion of the extent of diaphragmatic defect was confirmed by the close correlation between DDR and feasibility of primary repair in the study group. This objective assessment of defect size may improve comparing various surgical techniques and results of different centres, and thus facilitates sharing experience with management of neonates with CDH.
我们研究的目的是引入一种新的围手术期评估膈肌缺损大小的客观方法，以便能够比较不同中心以及用于膈肌重建的不同方法的结果。
对2009年1月至2011年12月出生后24小时内患有先天性膈疝（CDH）并伴有呼吸窘迫的新生儿进行前瞻性观察研究。测量体重、身长、胸廓形状和膈肌缺损的直径。为了确定缺损的相对大小，计算缺损-膈肌比率（DDR = 缺损面积:膈肌面积×100）。随后比较戈尔特斯补片组（GT）和一期修复组（PR）的测量数据和计算数据。采用曼-惠特尼U检验进行统计分析。
研究期间共收治47例CDH患者。总生存率为79%（37/47）。85%（40/47）的患者实现了术前稳定。手术新生儿的生存率为93%（37/40）。7例新生儿（17%）采用戈尔特斯补片进行膈肌重建，33例（83%）采用一期修复。戈尔特斯组的死亡率为29%；一期修复组的死亡率为3%。34名儿童（5名GT组和29名PR组）的人体测量数据完整。GT组和PR组在膈肌缺损大小方面存在显著差异，缺损的横径和矢状径分别为（48.0±5.7对30.1±5.9，P<0.00061；34.0±12.5对16.0±7.3，P<0.0022），DDR分别为（18.29±4.60对5.77±3.28，P<0.0005）。
DDR作为膈肌缺损范围的客观标准的价值在研究组中通过DDR与一期修复可行性之间的密切相关性得到了证实。这种对缺损大小的客观评估可能会改善对不同手术技术和不同中心结果的比较，从而有助于分享先天性膈疝新生儿管理的经验。
