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先天性膈疝:成人的人口统计学和 30 天结局。

Congenital Diaphragmatic Hernia: Demographics and 30-day Outcomes in Adults.

机构信息

Department of Surgery, 21638The University of Kansas, Kansas City, KS, USA.

出版信息

Am Surg. 2021 Aug;87(8):1341-1346. doi: 10.1177/0003134820960061. Epub 2020 Dec 19.

Abstract

BACKGROUND

Congenital diaphragmatic hernia (CDH) is a pathology most often affecting the pediatric population, although adults can also be affected. Few studies exist of adults undergoing repair of this defect. Using a national database, we sought to determine demographics and outcomes of this population.

METHODS

An analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database (2015-2018) was performed, capturing patients with postoperative diagnosis of CDH, distinct from ventral hernia. Two groups were created based upon surgical approach of open or minimally invasive (MIS) repair. Baseline demographics and outcomes were compared.

RESULTS

110 patients undergoing surgical correction of CDH were captured in the database. We found rates of return to the operating room (4.55%), postoperative respiratory failure (5.45%), and reintubation (3.64%) with no difference between groups. There was no mortality and no difference between groups in length of operation, discharge to home, or postoperative complications. Patients undergoing open repair had a longer length of stay than patients in the MIS group (6.47 ± 10.76 days vs. 3.68 ± 3.74 days, = .0471). Mesh was used in MIS more often than the open group (47.30% vs. 5.56%, < .0001).

DISCUSSION

This study describes rates of postoperative complications in patients undergoing repair of CDH, and suggests outcomes those are equivalent between patients receiving open or MIS approaches. Further case series or retrospective studies are needed to further describe this population of patients.

摘要

背景

先天性膈疝(CDH)是一种常见于儿科人群的疾病,尽管成人也可能受到影响。目前针对接受这种缺陷修复的成年人的研究较少。通过使用国家数据库,我们试图确定该人群的人口统计学和结果。

方法

对美国外科医师学院国家手术质量改进计划(ACS NSQIP)数据库(2015-2018 年)进行了分析,该数据库捕获了术后诊断为 CDH 的患者,与腹疝不同。根据开放或微创(MIS)修复的手术方法创建了两组。比较了基线人口统计学和结果。

结果

在数据库中捕获了 110 例接受手术矫正 CDH 的患者。我们发现,再次手术(4.55%)、术后呼吸衰竭(5.45%)和重新插管(3.64%)的发生率没有差异。两组均无死亡,手术时间、出院回家或术后并发症无差异。开放修复组的住院时间长于 MIS 组(6.47 ± 10.76 天比 3.68 ± 3.74 天, =.0471)。MIS 组中更常使用网片(47.30%比 5.56%, <.0001)。

讨论

本研究描述了接受 CDH 修复的患者的术后并发症发生率,并表明接受开放或 MIS 方法的患者的结果相当。需要进一步的病例系列或回顾性研究来进一步描述这一患者群体。

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