Boo Yoon Jung, Rohleder Stephan, Muensterer Oliver J
Department of Surgery, Division of Pediatric Surgery, Korea University College of Medicine, Seoul, South Korea.
Department of Pediatric Surgery, University Medicine of Johannes Gutenberg University, Mainz, Germany.
European J Pediatr Surg Rep. 2017 Jan;5(1):e26-e28. doi: 10.1055/s-0037-1604049. Epub 2017 Jul 28.
Closure of the posterolateral defect in some cases of congenital diaphragmatic hernia (CDH) can be difficult. Percutaneous transcostal suturing is often helpful to create a complete, watertight closure of the diaphragm. A challenge with the technique is passing the needle out the same tract that it entered so that no skin is caught when the knots are laid down into the subcutaneous tissue. This report describes a novel technique using a Tuohy needle to percutaneously suture the posterolateral defect during thoracoscopic repair of CDH. We report a case of a 6-week-old infant who presented with a CDH and ipsilateral intrathoracic kidney that was repaired using thoracoscopic approach. The posterolateral part of the defect was repaired by percutaneous transcostal suturing and extracorporeal knot tying. To assure correct placement of the sutures and knots, a Tuohy needle was used to guide the suture around the rib and out through the same subcutaneous tract. The total operative time was 145 minutes and there were no perioperative complications. The patient was followed up for 3 months, during which there was no recurrence. Our percutaneous Tuohy technique for closure of the posterolateral part of CDH enables a secure, rapid, and tensionless repair.
在某些先天性膈疝（CDH）病例中，闭合后外侧缺损可能具有挑战性。经皮肋缘缝合术通常有助于实现膈肌的完全、防水闭合。该技术的一个挑战是使针从其进入的同一通道穿出，以便在将结埋入皮下组织时不会夹住皮肤。本报告描述了一种在胸腔镜修复CDH期间使用Tuohy针经皮缝合后外侧缺损的新技术。
我们报告了一例6周大的婴儿，患有CDH和同侧胸腔内肾，采用胸腔镜方法进行修复。缺损的后外侧部分通过经皮肋缘缝合和体外打结进行修复。为确保缝线和结的正确放置，使用Tuohy针引导缝线绕过肋骨并从同一皮下通道穿出。总手术时间为145分钟，无围手术期并发症。对患者进行了3个月的随访，在此期间无复发。
我们用于闭合CDH后外侧部分的经皮Tuohy技术能够实现安全、快速且无张力的修复。
