Tanaka Takaaki, Okazaki Tadaharu, Fukatsu Yumi, Okawada Manabu, Koga Hiroyuki, Miyano Go, Ogasawara Yuki, Lane Geoffrey J, Yamataka Atsuyuki
Department of Pediatric Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan.
Pediatr Surg Int. 2013 Nov;29(11):1183-6. doi: 10.1007/s00383-013-3382-9.
To compare open repair (OR) with thoracoscopic repair (TR) for congenital diaphragmatic hernia (CDH) in neonates.
Twenty-four neonatal CDH cases diagnosed prenatally or within 6 h of birth at our institute from 2002 to 2012 with mild pulmonary hypertension managed without inhaled nitric oxide, were studied. OR was routine until 2006 (n = 14; L:R = 12:2) and TR became routine in 2007 (n = 10; L:R = 10:0). All subjects had identical management.
Gestational age at birth: OR 37.4 ± 1.6 vs. TR: 38.3 ± 1.1 weeks (p = 0.10); birth weight 2,636 ± 490 vs. 2,887 ± 429 grams (p = 0.20); preoperative A-aDO(2): 308 ± 200 vs. 331 ± 195 mmHg (p = 0.79); and operating time (min): 161 ± 42 vs. 194 ± 76 (p = 0.27). In TR, intraoperative cardiopulmonary status was stable, intraoperative hemorrhage was significantly less (4.8 ± 6.0 vs. 1.1 ± 0.1 grams; p = 0.038), wound cosmesis was excellent without surgical site infections, while, maximum postoperative CRP (2.0 ± 1.5 vs. 1.5 ± 1.1 mg/dL; p = 0.30), commencement of enteral feeding (6.9 ± 2.8 vs. 5.6 ± 2.8 days; p = 0.27), and length of postoperative hospitalization (36 ± 22 vs. 34 ± 12 days; p = 0.66) were improved, but not significantly. One OR case required surgery for intestinal obstruction.
Thoracoscopic repair appears to be as effective as OR for treating selected cases of CDH in neonates, with excellent wound cosmesis.
比较开放性修补术（OR）与胸腔镜修补术（TR）治疗新生儿先天性膈疝（CDH）的效果。
研究对象为2002年至2012年在我院产前或出生后6小时内诊断为CDH且伴有轻度肺动脉高压、无需吸入一氧化氮治疗的24例新生儿。2006年之前常规采用OR（n = 14；左侧：右侧 = 12：2），2007年起常规采用TR（n = 10；左侧：右侧 = 10：0）。所有受试者的管理方式相同。
出生时的孕周：OR组为37.4 ± 1.6周，TR组为38.3 ± 1.1周（p = 0.10）；出生体重：OR组为2,636 ± 490克，TR组为2,887 ± 429克（p = 0.20）；术前肺泡 - 动脉氧分压差（A - aDO₂）：OR组为308 ± 200 mmHg，TR组为331 ± 195 mmHg（p = 0.79）；手术时间（分钟）：OR组为161 ± 42分钟，TR组为194 ± 76分钟（p = 0.27）。在TR组中，术中心肺状态稳定，术中出血量显著减少（4.8 ± 6.0克 vs. 1.1 ± 0.1克；p = 0.038），伤口美观度极佳，无手术部位感染，而术后最高C反应蛋白（2.0 ± 1.5 mg/dL vs. 1.5 ± 1.1 mg/dL；p = 0.30）、开始肠内喂养时间（6.9 ± 2.8天 vs. 5.6 ± 2.8天；p = 0.27）以及术后住院时间（36 ± 22天 vs. 34 ± 12天；p = 0.66）虽有所改善，但差异不显著。1例OR组病例因肠梗阻需要再次手术。
对于新生儿CDH的某些病例，胸腔镜修补术似乎与开放性修补术效果相当，且伤口美观度极佳。
