Department of Pediatric Surgery, Faculty of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan.
Pediatr Surg Int. 2024 May 7;40(1):125. doi: 10.1007/s00383-024-05706-z.
Postoperative pulmonary growth in congenital diaphragmatic hernias (CDH) remains unclear. We investigated postoperative pulmonary vascular growth using serial lung perfusion scintigraphy in patients with CDH.
Neonates with left CDH who underwent surgery and postoperative lung perfusion scintigraphy at our institution between 2001 and 2020 were included. Patient demographics, clinical courses, and lung scintigraphy data were retrospectively analyzed by reviewing medical records.
Twenty-one patients with CDH were included. Of these, 10 underwent serial lung scintigraphy. The ipsilateral perfusion rate and median age on the 1st and serial lung scintigraphy were 32% (34 days) and 33% (3.6 years), respectively. Gestational age at prenatal diagnosis (p = 0.02), alveolar-arterial oxygen difference (A-aDO) at birth (p = 0.007), and preoperative nitric oxide (NO) use (p = 0.014) significantly correlated with the 1st lung scintigraphy. No other variables, including operative approach, were significantly correlated with the 1st or serial scintigraphy findings. All patients improved lung perfusion with serial studies [Difference: + 7.0 (4.3-13.25) %, p = 0.001, paired t-test]. This improvement was not significantly correlated with preoperative A-aDO (p = 0.96), NO use (p = 0.28), or liver up (p = 0.90). The difference was significantly larger in patients who underwent thoracoscopic repair than in those who underwent open abdominal repair [+ 10.6 (5.0-17.1) % vs. + 4.25 (1.2-7.9) %, p = 0.042].
Our study indicated a postoperative improvement in ipsilateral lung vascular growth, which is possibly enhanced by a minimally invasive approach, in patients with CDH.
先天性膈疝（CDH）患者术后肺生长情况仍不清楚。我们通过对 CDH 患者进行系列肺灌注闪烁显像来研究术后肺血管生长情况。
纳入 2001 年至 2020 年期间在我院行手术治疗和术后肺灌注闪烁显像的左侧 CDH 新生儿。回顾病历，分析患者的人口统计学资料、临床病程和肺闪烁显像资料。
共纳入 21 例 CDH 患者，其中 10 例行系列肺闪烁显像。患侧灌注率和第 1 次及系列肺闪烁显像的中位年龄分别为 32%（34 天）和 33%（3.6 岁）。产前诊断时的胎龄（p=0.02）、出生时的肺泡-动脉氧差（A-aDO）（p=0.007）和术前一氧化氮（NO）使用（p=0.014）与第 1 次肺闪烁显像显著相关。其他变量，包括手术方式，与第 1 次或系列闪烁显像结果均无显著相关性。所有患者的肺灌注均随系列研究而改善（差异：+7.0（4.3-13.25）%，p=0.001，配对 t 检验）。这种改善与术前 A-aDO（p=0.96）、NO 使用（p=0.28）或肝脏上移（p=0.90）均无显著相关性。胸腔镜修补术患者的差异明显大于开腹修补术患者（+10.6（5.0-17.1）% vs. +4.25（1.2-7.9）%，p=0.042）。
本研究表明，CDH 患者术后患侧肺血管生长改善，微创方法可能增强这种改善。
