Nagaya M, Akatsuka H, Kato J
Department of Pediatric Surgery, Central Hospital, Kasugai, Japan.
J Pediatr Surg. 1994 Nov;29(11):1447-51. doi: 10.1016/0022-3468(94)90141-4.
Over the past 2 decades, 110 patients with congenital diaphragmatic hernia (CDH) were treated in the authors' hospital. Eighty-six survived; of these, 10 patients (11.6%) had gastroesophageal reflux (GER) after repair of CDH. Seven occurred in the past 5 years, during which time advanced intensive care including extracorporeal membrane oxygenation (ECMO) was used. Vomiting started within 4 weeks after repair of CDH in eight cases, and hiatal hernia was demonstrated in six cases. Three patients responded to conservative therapy; the other seven required antireflux surgery. Several factors are believed to be possible causes of the development of GER in CDH cases. Among them, slow pulmonary expansion of the affected side was thought to be the most important. Namely, in a case of CDH associated with severe hypoplastic lung, the esophagus may be deviated to the affected side before the lung is expanded. After expansion, the abdominal esophagus shortens, and GER or a hiatal hernia can occur in severe cases. There were seven such patients in our series of 10. With the increase in the survival rate of CDH cases associated with severe hypoplastic lung, the number of such patients also may increase. Therefore, some additional procedure to prevent the lower esophagus from sliding will be necessary in the repair of diaphragmatic hernia.
在过去20年里，作者所在医院共治疗了110例先天性膈疝（CDH）患者。其中86例存活；在这些存活患者中，有10例（11.6%）在CDH修补术后出现胃食管反流（GER）。7例发生在过去5年，在此期间采用了包括体外膜肺氧合（ECMO）在内的先进重症监护治疗。8例患者在CDH修补术后4周内开始出现呕吐，6例经检查发现有食管裂孔疝。3例患者对保守治疗有效；另外7例需要进行抗反流手术。据信，有几个因素可能是CDH病例中GER发生的原因。其中，患侧肺扩张缓慢被认为是最重要的因素。也就是说，在伴有严重肺发育不全的CDH病例中，在肺扩张之前食管可能会偏向患侧。肺扩张后，腹段食管缩短，严重时可发生GER或食管裂孔疝。在我们的10例此类患者系列中，有7例属于这种情况。随着伴有严重肺发育不全的CDH病例存活率的提高，这类患者的数量可能也会增加。因此，在膈疝修补术中，可能需要采取一些额外的措施来防止食管下段滑动。
