猪皮补丁作为先天性膈疝修补术后复发的危险因素。
Porcine dermal patches as a risk factor for recurrence after congenital diaphragmatic hernia repair.
机构信息
Department of Pediatric Surgery, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain.
Department of Neonatology, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Barcelona, Spain.
出版信息
Pediatr Surg Int. 2021 Jan;37(1):59-65. doi: 10.1007/s00383-020-04787-w. Epub 2020 Nov 27.
PURPOSE
Recurrence of congenital diaphragmatic hernia (CDH) is a treatment-related morbidity which can be preventable. There is no consensus about the ideal material for diaphragmatic substitution. The aim of our study is to identify if the use of porcine dermis patches increases the risk of CDH recurrence.
METHODS
Retrospective review of medical records of CDH patients treated between 2013 and 2017 in our center was carried out. Demographic, clinical and surgical variables were collected. Regression analysis was performed to identify which factors increase the risk of recurrence.
RESULTS
50 patients entered the study. 94% of the patients had a left CDH, mean observed/expected lung-to-head ratio was 46%. 17 patients underwent a primary closure, the rest a patch closure: 25 Gore-Tex and 8 porcine dermis patches were used. Seven patients presented recurrence (14%). Median follow-up time was 3.5 years (1.2-6.2). Univariate analysis revealed that the use of a porcine dermis patch (75%) increased the risk of recurrence compared with Gore-Tex patch (4%) and primary closure (0%) p < 0.001 (HR 58.7; IC 95%: 6.9-501.2; p < 0.001).
CONCLUSION
The main risk factor for CDH recurrence is the use of a porcine dermis patch. We do not recommend the use of these patches for CDH repair.
目的
先天性膈疝（CDH）的复发是一种与治疗相关的发病率，是可以预防的。对于膈替代的理想材料尚无共识。我们研究的目的是确定使用猪真皮补丁是否会增加 CDH 复发的风险。
方法
对 2013 年至 2017 年在我们中心治疗的 CDH 患者的病历进行回顾性研究。收集人口统计学、临床和手术变量。进行回归分析以确定哪些因素增加复发的风险。
结果
50 例患者入组研究。94%的患者为左侧 CDH，观察到的/预期的肺头比平均值为 46%。17 例患者行一期缝合，其余行补丁缝合：25 例 Gore-Tex 和 8 例猪真皮补丁。7 例患者出现复发（14%）。中位随访时间为 3.5 年（1.2-6.2）。单因素分析显示，与 Gore-Tex 补丁（4%）和一期缝合（0%）相比，使用猪真皮补丁（75%）增加了复发的风险，p<0.001（HR 58.7；95%CI：6.9-501.2；p<0.001）。
结论
CDH 复发的主要危险因素是使用猪真皮补丁。我们不建议将这些补丁用于 CDH 修复。
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