Collins D L, Pomerance J J, Travis K W, Turner S W, Pappelbaum S J
J Pediatr Surg. 1977 Apr;12(2):149-56. doi: 10.1016/s0022-3468(77)80001-8.
The theory is advanced that increased pulmonary vascular resistance, resulting in a state of fetal circulation, with right-to-left shunting through the ductus arteriosus, is the main reason that many patients do not survive after repair of a diaphragmatic hernia. Three patients are presented (who, by Raphaely's criteria, were destined for a fatal outcome) in whom the ductus was ligated, and vasodilator drugs were infused into the pulmonary artery. All three demonstrated definite improvement in oxygenation. Two expired after 6 days, one of whom was found at autopsy to have intestinal volvulus and gangrene, and the other multiple plumonary emboli. One case, so managed, survived. The suggestion is made that pulmonary hypoplasia is not the main reason for the high mortality rate after diaphragmatic hernia repair, and that additional laboratory and clinical investigation of the pulmonary circulation may lead to significant improvement in results.
有一种理论认为，肺血管阻力增加导致胎儿循环状态，通过动脉导管出现右向左分流，这是许多患者在膈疝修补术后无法存活的主要原因。本文介绍了3例患者（根据拉斐利的标准，他们注定会有致命结局），对其动脉导管进行了结扎，并将血管扩张药物注入肺动脉。所有3例患者的氧合情况均有明显改善。2例在6天后死亡，其中1例尸检发现有肠扭转和坏疽，另1例有多发肺栓塞。1例经如此治疗后存活。有人提出，肺发育不全并非膈疝修补术后高死亡率的主要原因，对肺循环进行更多的实验室和临床研究可能会显著改善治疗结果。
