McHoney Merrill
Royal Hospital for Sick Children Edinburgh, Sciennes Road, Edinburgh, EH1 1LF, UK.
Early Hum Dev. 2014 Dec;90(12):941-6. doi: 10.1016/j.earlhumdev.2014.09.013. Epub 2014 Oct 18.
There is a paucity of level 1 and level 2 evidence for best practice in surgical management of CDH. Antenatal imaging and prognostication is developing. Observed to expected lung-to-head ratio on ultrasound allows better predictive value over simple lung-to-head ratio. Based on 2 randomised studies, the verdict is still out in terms the best group and indication for antenatal intervention and their outcome. Tracheal occlusion is best suited for prospective randomised studies of benefit and outcome. Only one pilot randomised controlled study of thoracoscopic repair exists, suggesting increased acidosis; blood gases and CO2 levels should be closely monitored. Only poorly controlled retrospective studies suggest higher recurrence rates. Randomised studies on the outcome of thoracoscopic repair are needed. Careful selection, anaesthetic vigilance, monitoring and follow-up of these cases are required. There is no evidence to suggest the best patch material to decrease recurrences. Evidence suggests no benefit from routine fundoplication based on the one randomised study. Multi-disciplinary follow-up is required. This can be visits to different specialities, but may be best served by a multi-disciplinary one-stop clinic.
关于先天性膈疝（CDH）手术管理的最佳实践，一级和二级证据匮乏。产前影像学和预后评估正在发展。超声检查时观察到的肺头比相对于单纯的肺头比具有更好的预测价值。基于两项随机研究，关于产前干预的最佳人群、指征及其结果尚无定论。气管阻塞最适合进行关于益处和结果的前瞻性随机研究。目前仅有一项关于胸腔镜修复的初步随机对照研究，提示酸中毒增加；应密切监测血气和二氧化碳水平。仅有控制不佳的回顾性研究提示复发率较高。需要开展关于胸腔镜修复结果的随机研究。对这些病例需要进行仔细的选择、麻醉监测以及随访。没有证据表明哪种补片材料能最佳地降低复发率。基于一项随机研究，没有证据表明常规行胃底折叠术有益。需要多学科随访。这可以是到不同专科就诊，但由多学科一站式诊所来做可能效果最佳。
