Texas Children's Fetal Center, Houston, TX, USA; Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Center for Regenerative Medicine, Nationwide Children's Hospital, 575 Children's Drive, Columbus, OH 43205, USA.
J Pediatr Surg. 2022 Apr;57(4):637-642. doi: 10.1016/j.jpedsurg.2021.10.014. Epub 2021 Oct 22.
To develop a quantifiable approach to identify a dome shape of the repaired diaphragm using post-operative chest radiograph and to determine if a dome-shaped prosthetic patch repair is associated with a decreased rate of CDH recurrence.
We conducted a retrospective review of all neonates evaluated at our institution from January 2004 to August 2017 with left- and right-sided CDH with at least 6 months of follow-up after CDH repair. Patch use, post-operative imaging and postnatal outcomes were analyzed. Neonates with patch repair were divided into two groups based on the presence of a dome. Using postoperative chest radiographs, the presence of a dome was classified as having a vertical-horizontal diaphragm ratio (VHDR) greater than 20%. Primary outcome was CDH recurrence after repair.
We identified 192 neonates who met our inclusion criteria. Cohort survival was 96%, recurrence rate was 15%, 78% had a left-sided CDH; 54% received a patch repair, of which 58% had a type C defect. Of the 104 infants with patch repairs, the CDH recurrence rate was 22% (n = 23) at a median age of 8.5 months (3.8, 20.1). Although neonates with a dome repair had more ECMO use and longer hospital stay, their recurrence rate was about half of those with a non-dome repair (14% vs 28%, p = 0.07).
A dome-shaped repair may reduce recurrence following prosthetic patch repair of congenital diaphragmatic hernia. A larger, multi-institutional study is needed to statistically validate this clinically significant observation.
Retrospective review.
III.
利用术后胸部 X 线片开发一种量化方法来识别修复后的膈肌穹顶形状，并确定穹顶状补片修复是否与 CDH 复发率降低相关。
我们对 2004 年 1 月至 2017 年 8 月期间在我院接受左侧和右侧 CDH 评估且在 CDH 修复后至少有 6 个月随访的所有新生儿进行了回顾性研究。分析补片使用、术后影像学表现和出生后结局。根据是否存在穹顶，将接受补片修复的新生儿分为两组。使用术后胸部 X 线片，将穹顶的存在分为垂直-水平膈肌比（VHDR）大于 20%。主要结局为修复后 CDH 复发。
我们确定了 192 名符合纳入标准的新生儿。队列生存率为 96%，复发率为 15%，78%为左侧 CDH；54%接受了补片修复，其中 58%存在 C 型缺损。在 104 名接受补片修复的婴儿中，CDH 复发率为 22%（n=23），中位年龄为 8.5 个月（3.8，20.1）。尽管穹顶修复的新生儿 ECMO 使用更多且住院时间更长，但他们的复发率约为非穹顶修复的一半（14%比 28%，p=0.07）。
在先天性膈疝补片修复后，穹顶状修复可能会降低复发率。需要更大规模的多机构研究来对这一具有临床意义的观察结果进行统计学验证。
回顾性研究。
III。
