Morsberger Jill L, Short Heather L, Baxter Katherine J, Travers Curtis, Clifton Matthew S, Durham Megan M, Raval Mehul V
Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA.
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
J Pediatr Surg. 2019 Apr;54(4):645-650. doi: 10.1016/j.jpedsurg.2018.06.009. Epub 2018 Jun 18.
The aim of this study was to determine long-term outcomes for congenital diaphragmatic hernia (CDH) patients including quality of life (QoL), symptom burden, reoperation rates, and health status.
A chart review and phone QoL survey were performed for patients who underwent CDH repair between 2007 and 2014 at a tertiary free-standing children's hospital. Comprehensive outcomes were collected including subsequent operations and health status. Associations with QoL were tested using Wilcoxon Rank-Sum tests and Pearson correlation coefficients.
Of 102 CDH patients identified, 46 (45.1%) patient guardians agreed to participate with mean patient age of 5.8 (SD, 2.2) years at time of follow-up. Median PedsQL and PedsQL Gastrointestinal scores were 91.8 (IQR, 84.8-95.8) and 95.8 (IQR, 93.0-98.2), out of 100. Thoracoscopic repair was associated with higher PedsQL scores while defects with an intrathoracic stomach were associated with increased gas and bloating. No difference in QoL was found when comparing defect side, patch vs primary repair, prenatal diagnosis, extracorporeal membrane oxygenation, or recurrence. Older age weakly correlated with worse school functioning and heartburn.
Children with CDH have reassuring QoL scores. Given the correlation between older age and poor school function, longer follow-up of patients with CDH may be warranted.
III (Retrospective comparative study).
本研究的目的是确定先天性膈疝（CDH）患者的长期预后，包括生活质量（QoL）、症状负担、再次手术率和健康状况。
对2007年至2014年在一家三级独立儿童医院接受CDH修复手术的患者进行病历审查和电话生活质量调查。收集了包括后续手术和健康状况在内的综合结果。使用Wilcoxon秩和检验和Pearson相关系数测试与生活质量的关联。
在确定的102例CDH患者中，46例（45.1%）患者的监护人同意参与，随访时患者的平均年龄为5.8（标准差，2.2）岁。PedsQL和PedsQL胃肠道评分中位数分别为91.8（四分位间距，84.8 - 95.8）和95.8（四分位间距，93.0 - 98.2）（满分100分）。胸腔镜修复与较高的PedsQL评分相关，而胸腔内胃的缺损与气体和腹胀增加相关。比较缺损侧、补片修补与一期修补、产前诊断、体外膜肺氧合或复发情况时，未发现生活质量有差异。年龄较大与较差的学校功能和烧心症状呈弱相关。
CDH患儿的生活质量评分令人安心。鉴于年龄较大与学校功能较差之间的相关性，可能需要对CDH患者进行更长时间的随访。
III（回顾性比较研究）。
