Kieffer J, Sapin E, Berg A, Beaudoin S, Bargy F, Helardot P G
Department of Pediatric Surgery, Hospital Saint Vincent de Paul, Paris, France.
J Pediatr Surg. 1995 Sep;30(9):1330-3. doi: 10.1016/0022-3468(95)90497-2.
Seventy-four survivors of congenital diaphragmatic hernia (CDH) repair were reviewed for gastroesophageal reflux (GER). Twenty-nine patients had a prenatal diagnosis of CDH, 31 had the diagnosis established during the first 60 minutes of life, and 14 had a late diagnosis. Fifty-seven of the 60 patients with a prenatal diagnosis or diagnosis at birth had their CDH repaired during the first 24 hours of life. Thirty-six of the 37 patients with clinical signs of GER and 10 patients without typical clinical signs had documented GER. The overall incidence of GER was 62% (46 of 74). The 46 comprised 22 of the 29 patients (75.8%) with a prenatal diagnosis of CDH, 21 of the 31 (67.7%) with a diagnosis at birth, and 3 of the 14 with a late diagnosis. Eleven patients had surgical treatment of GER. A significant correlation was found between GER and the preoperative thoracic position of the stomach (32 v 8, GER+ v GER-; P < .01) and GER and the prenatal diagnosis of CDH (22 v 7, GER+ v GER-; P < .01). Duration of artificial ventilation (68.97 +/- 15.33 days v 14.14 +/- 3.89 days, GER+ v GER-; P < .005) and duration of hospitalization (22.04 +/- 3.59 weeks v 3.9 +/- 0.88 weeks, GER+ v GER-; P < .0003) were significantly longer for the patients with pathological GER. To decrease the morbidity related to GER, we propose using diaphragmatic patches during hernia repair to lower the strain on the crus, and using parietal patches to lower intraabdominal pressure after reintroduction of the herniated viscera.
对74例先天性膈疝（CDH）修补术后的幸存者进行了胃食管反流（GER）情况评估。29例患者产前诊断为CDH，31例在出生后60分钟内确诊，14例为晚期诊断。60例产前诊断或出生时确诊的患者中，57例在出生后24小时内接受了CDH修补术。37例有GER临床症状的患者中，36例以及10例无典型临床症状的患者经检查证实存在GER。GER的总体发生率为62%（74例中的46例）。这46例中包括29例产前诊断为CDH的患者中的22例（75.8%），31例出生时确诊的患者中的21例（67.7%），以及14例晚期诊断患者中的3例。11例患者接受了GER手术治疗。发现GER与术前胃在胸腔内的位置（GER阳性组32例对GER阴性组8例；P <.01）以及GER与CDH的产前诊断（GER阳性组22例对GER阴性组7例；P <.01）之间存在显著相关性。病理性GER患者的人工通气时间（GER阳性组68.97±15.33天对GER阴性组14.14±3.89天；P <.005）和住院时间（GER阳性组22.04±3.59周对GER阴性组3.9±0.88周；P <.0003）明显更长。为降低与GER相关的发病率，我们建议在疝修补术中使用膈肌补片以减轻膈脚的张力，并在将疝出的脏器回纳后使用壁层补片以降低腹内压。
