Yuan Miao, Xu Chang, Xiang Bo, Huang Lugang, Jiang Xiaoping, Yang Gang
Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 May 8;30(5):590-593. doi: 10.7507/1002-1892.20160119.
To explore the effectiveness of thoracoscopic surgery for treating late-presenting congenital diaphragmatic hernias and summarize the experience.
Between October 2012 and February 2015, 21 children with late-presenting congenital diaphragmatic hernias underwent thoracoscopic surgery. Of the 21 cases, 12 were girls and 9 were boys with a median age of 1 year and 3 months (range, 2 months to 8 years). Eight patients had obvious symptom in the initial stage:shortness of breath and dyspnea; 13 cases were found occasionally through chest radiography. Of 21 cases, 17 had left diaphragmatic hernias and 4 had right diaphragmatic hernias. The emergency surgery was performed in 5 cases because oppressed obviously and selective operation in 16 cases. Hernial sac existed in 5 cases; there were 19 cases of Bochdalek's hernia and 2 cases of Morgagni's hernia. The size of diaphragmatic defect ranged from 3 cm×2 cm to 5 cm×5 cm.
The operation time was 35-80 minutes (mean, 50 minutes), and intraoperative blood loss was 3-5 mL (mean, 3.8 mL). Primary healing of incision was obtained. Postoperative abdominal distension and pneumothorax occurred in 12 and 2 cases respectively. The follow-up time was 1-3 years (mean, 20 months). All the cases had a good recovery and satisfactory appearance of the thoracic incision. The symptoms and signs of shortness of breath and dyspnea disappeared. There was no recurrence and chest infection.
Under the conditions of mastering operative indications strictly, thoracoscopic repair for late-presenting congenital diaphragmatic hernia is safe and feasible. It can facilitate the procedure and decrease the recurrence rate relying on intraoperative application of hernia repair needle, knot pusher-assistant, and reasonable processing defect periphery.
探讨胸腔镜手术治疗迟发性先天性膈疝的疗效并总结经验。
2012年10月至2015年2月，21例迟发性先天性膈疝患儿接受了胸腔镜手术。21例中，女12例，男9例，中位年龄1岁3个月（范围2个月至8岁）。8例患儿初期有明显症状：呼吸急促和呼吸困难；13例经胸部X线偶然发现。21例中，17例为左侧膈疝，4例为右侧膈疝。5例因压迫明显行急诊手术，16例行选择性手术。5例存在疝囊；19例为波氏孔疝，2例为莫氏疝。膈缺损大小为3cm×2cm至5cm×5cm。
手术时间35 - 80分钟（平均50分钟），术中失血3 - 5ml（平均3.8ml）。切口一期愈合。术后分别有12例和2例出现腹胀和气胸。随访时间1 - 3年（平均20个月）。所有病例恢复良好，胸部切口外观满意。呼吸急促和呼吸困难的症状及体征消失。无复发及胸部感染。
在严格掌握手术适应证的条件下，胸腔镜修补迟发性先天性膈疝安全可行。术中应用疝修补针、打结辅助器并合理处理缺损周边，可简化手术操作并降低复发率。
