Pediatric Surgery Department, Hospital de Pediatria J. P. Garrahan, Combate de los Pozos 1881, C 1245 AAM, Buenos Aires, Argentina.
Pediatric Surgery Department, Hospital de Pediatria J. P. Garrahan, Combate de los Pozos 1881, C 1245 AAM, Buenos Aires, Argentina.
J Pediatr Surg. 2021 Nov;56(11):1957-1961. doi: 10.1016/j.jpedsurg.2021.02.052. Epub 2021 Feb 25.
The aim of this study is to compare outcome between small intestinal submucosal (SIS) and polytetrafluoroethylene (PTFE) patches in patients with congenital diaphragmatic hernia (CDH) with large muscular defects.
We performed a retrospective review of prospectively collected data of patients who underwent CDH repair from January 2011 to June 2019, with a minimum follow-up of 1 year. Data were collected regarding length of stay (LOS), mortality and recurrence. Kaplan-Meier analyses was used.
In the study period, 195 patients with CDH were admitted, 176 underwent surgical repair and 19 died before surgery. Sixty-two (35%) required a patch. Over the last 5 years, our institution transitioned from the use of all SIS to all PTFE. SIS was used in 18 cases and PTFE in 25. Overall survival rate was 89% (174/195). There was no significant difference regarding LOS and mortality. Nine patients (50%) of SIS and 1 (4%) of PTFE repairs recurred (P < 0.01; log-rank test P < 0.01), with a time course of recurrence of 18 (SD = 13) and 8 months, respectively. Median follow-up was 60 months (SD: 23) for the SIS group and 26 (SD: 10) for the PTFE group.
A significant lower recurrence was found using PTFE patches instead of SIS for the repair of large CDH.
Level 3. Retrospective comparative study.
本研究旨在比较先天性膈疝（CDH）伴大肌缺损患者使用小肠黏膜下层（SIS）和聚四氟乙烯（PTFE）补丁的结果。
我们对 2011 年 1 月至 2019 年 6 月期间接受 CDH 修复的患者前瞻性收集的数据进行了回顾性分析，随访时间至少为 1 年。收集了住院时间（LOS）、死亡率和复发的数据。采用 Kaplan-Meier 分析。
在研究期间，195 例 CDH 患者入院，176 例行手术修复，19 例在术前死亡。62 例（35%）需要修补。在过去的 5 年中，我们机构从使用所有 SIS 过渡到了使用所有 PTFE。SIS 用于 18 例，PTFE 用于 25 例。总体生存率为 89%（174/195）。LOS 和死亡率无显著差异。SIS 组有 9 例（50%）和 PTFE 组有 1 例（4%）复发（P<0.01；log-rank 检验 P<0.01），复发时间分别为 18（SD=13）和 8 个月。SIS 组的中位随访时间为 60 个月（SD：23），PTFE 组为 26 个月（SD：10）。
使用 PTFE 补丁而非 SIS 修补大 CDH，复发率显著降低。
3 级。回顾性比较研究。
