Department of Thoracic Surgery, UZ Leuven, KU, Leuven, Belgium; Research Department of Development and Regeneration, KU, Leuven, Belgium.
Department of Specialist Neonatal and Pediatric Surgery, Great Ormond Street Hospital London, United Kingdom.
J Pediatr Surg. 2020 Oct;55(10):2105-2110. doi: 10.1016/j.jpedsurg.2019.12.020. Epub 2020 Jan 8.
The surgical strategy for congenital diaphragmatic hernia (CDH) repair remains debated and mainly depends on the training and preference of the surgeon. Our aim was to evaluate the occurrence and nature of surgical reinterventions within the first year of life, following repair through thoracotomy as compared to laparotomy.
This is a retrospective bi-centric cohort study comparing postero-lateral thoracotomy (n = 55) versus subcostal laparotomy (n = 62) for CDH repair (IRB: MP001882). We included neonates with isolated, left-sided, Bochdalek-type CDH who were operated on between 2000 and 2017, and had a minimum follow-up of 1 year. Excluded were patients treated prenatally and/or had extra-corporeal membrane oxygenation. Outcomes were occurrence and nature of surgical reinterventions and mortality by 1 year of life.
Both groups had comparable neonatal severity risk profiles. The overall surgical reintervention rate by 1 year of age was higher in the thoracotomy group (29.1% vs. 6.5%; p = 0.001), mainly because of a higher prevalence of acute bowel complications (18.1% vs. 3.2%; p = 0.012) requiring surgery, such as perforation, obstruction and volvulus. At 1 year of follow-up, groups were similar in terms of recurrence (5.5% vs. 1.6%; p = 0.341), surgical interventions related to severe gastroesophageal reflux disease (3.6% vs. 1.6%; p = 0.600) and mortality (5.5% vs. 6.6%; p = 1.000).
Postnatal CDH repair through thoracotomy was associated with a higher rate of surgical reinterventions within the first year of life, especially for severe acute gastro-intestinal complications. There seemed to be no difference in recurrence and mortality rate.
Retrospective Comparative Cohort Study.
Level III.
先天性膈疝（CDH）的手术策略仍存在争议，主要取决于外科医生的培训和偏好。我们的目的是评估经胸入路与经腹入路修复后，患儿在出生后 1 年内再次手术的发生率和性质。
这是一项回顾性双中心队列研究，比较了经胸后外侧入路（n=55）与经腹肋缘下入路（n=62）治疗 CDH 的效果（IRB：MP001882）。我们纳入了 2000 年至 2017 年期间接受手术治疗的、具有孤立性、左侧、Bochdalek 型 CDH 的新生儿，且随访时间至少 1 年。排除了产前治疗和/或体外膜氧合治疗的患儿。主要结局为 1 岁时再次手术的发生率和性质，以及死亡率。
两组患儿的新生儿严重程度风险特征相似。1 岁时，经胸组的再次手术率（29.1% vs. 6.5%；p=0.001）更高，主要是因为急性肠并发症（穿孔、梗阻和扭转）需要手术的发生率更高（18.1% vs. 3.2%；p=0.012）。1 年随访时，两组患儿的复发率（5.5% vs. 1.6%；p=0.341）、与严重胃食管反流病相关的手术干预率（3.6% vs. 1.6%；p=0.600）和死亡率（5.5% vs. 6.6%；p=1.000）相似。
经胸入路治疗 CDH 后，患儿在出生后 1 年内再次手术的风险更高，尤其是出现严重的急性胃肠道并发症。但两组患儿的复发率和死亡率无差异。
回顾性比较队列研究。
III 级。
