Cao Guo-qing, Tang Shao-tao, Aubdoollah Tajammool Hussein, Yang Li, Li Shuai, Lei Hai-yan, Zhang Xi, Li Kang, Wang Xin-xing, Xiang Xian-cai
Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China .
J Laparoendosc Adv Surg Tech A. 2015 Oct;25(10):852-7. doi: 10.1089/lap.2014.0675. Epub 2015 Aug 27.
To report our technique and experiences in the laparoscopic diaphragmatic hemiplication (LDHP) in children with acquired diaphragmatic eventration after congenital heart surgery.
Between October 2007 to December 2013, 3498 children with congenital heart disease underwent cardiac surgery in our hospital, and 40 (1.14%) of them had unilateral diaphragmatic elevation on postoperative chest X-ray (mean elevation, 2.5 ± 0.26 intercostal spaces [ICS]) and were diagnosed as having diaphragmatic eventration due to diaphragmatic hemiparesis as a result of phrenic nerve injury. These 40 patients were followed up, and 22 of them recovered after conservative treatment; the other 18 needed surgical intervention. We conducted a retrospective study relating to surgical indications, surgical technique, complications, and outcomes.
There were 24 boys and 16 girls with a mean age of 10.0 ± 4.5 months old (range, 2 months-4 years). Twenty-two patients did not require surgical intervention. Eighteen patients underwent LDHP (12 cases left-sided and 6 cases right-sided); 2 of them had emergency LDHP with a history of ventilator dependency after cardiac surgery, and 16 of them had planned LDHP with a history of recurrent pneumonia and dyspnea. The operative time was 60 ± 7.9 minutes (range, 45-105 minutes), with minimal blood loss (3 ± 1.5 mL [range, 1-9 mL]), no intra- or postoperative complications, and postoperative hospital stay of 7 ± 1.3 days (range, 5-10 days). The diaphragmatic drop was 2.4 ± 0.2 (range, 2-4 ICS) without recurrence, and the follow-up time for all 40 patients was 14.8 ± 1.6 months (range, 11-36 months).
Our study further shows that LDHP is feasible and effective in selected patients after congenital heart surgery. Our technique is convenient and provides excellent clinical and radiological results.
报告我们在先天性心脏病手术后获得性膈膨升患儿中进行腹腔镜膈半肌折叠术（LDHP）的技术和经验。
2007年10月至2013年12月期间，我院3498例先天性心脏病患儿接受了心脏手术，其中40例（1.14%）术后胸部X线片显示单侧膈肌抬高（平均抬高2.5±0.26个肋间间隙[ICS]），因膈神经损伤导致膈肌轻瘫而被诊断为膈膨升。对这40例患者进行随访，其中22例经保守治疗后康复；另外18例需要手术干预。我们对手术指征、手术技术、并发症及结果进行了回顾性研究。
共24例男孩和16例女孩，平均年龄10.0±4.5个月（范围2个月至4岁）。22例患者无需手术干预。18例患者接受了LDHP（左侧12例，右侧6例）；其中2例因心脏手术后有呼吸机依赖史而进行了急诊LDHP，16例因有反复肺炎和呼吸困难史而进行了择期LDHP。手术时间为60±7.9分钟（范围45至105分钟），出血量极少（3±1.5 mL[范围1至9 mL]），无术中或术后并发症，术后住院时间为7±1.3天（范围5至10天）。膈肌下降2.4±0.2（范围2至4个ICS），无复发，40例患者的随访时间为14.8±1.6个月（范围11至36个月）。
我们的数据进一步表明，LDHP在先天性心脏病手术后的特定患者中是可行且有效的。我们的技术简便，可提供良好的临床和影像学结果。
