Pediatric thoracoscopic repair of congenital diaphragmatic hernias.
Pediatric thoracoscopic repair of congenital diaphragmatic hernias.
复制标题
小儿胸腔镜修复先天性膈疝。
DOI：
10.21037/jovs.2018.02.03
复制
发表时间：
2018
期刊：
影响因子：
--
通讯作者：
F. Becmeur
中科院分区：
文献类型：
--
作者：
A. Schneider;F. Becmeur
先天性腹股沟疝是一种罕见的先天性疾病，需要新生儿手术治疗。CDH的传统外科治疗包括经腹手术的血管修复。胸腔镜修复技术已被广泛描述用于晚期CDH。然而，其可行性CDH治疗新生儿出现在过去的几年中，因为使用胸腔镜与二氧化碳吹入仍然存在争议，在这些患者更容易体温过低和酸中毒。然而，我们认为胸腔镜可以安全地用于修复选定患者的CDH，主要限制因素是肺发育不良。一些患者因其技术难度和手术时间增加而更有可能需要补片闭合，因此应排除。小儿外科医生、麻醉师和儿科医生之间的密切合作是必不可少的。我们在这里讨论患者选择标准，暴露术前和术后管理，手术步骤;关于我们的经验，我们提供了一些提示，以实现儿科患者最安全的手术。
Congenital diaphragmatic hernia (CDH) is a rare congenital disease requiring neonatal surgical treatment. The traditional surgical management of CDH consists of diaphragmatic repair by laparotomy. Thoracoscopic repair techniques have been well described for CDH with late presentation. Nevertheless, its feasibility for CDH treatment in neonates emerged only the past few years because the use of thoracoscopy with carbon dioxide insufflation remains controversial in these patients more vulnerable to hypothermia and acidosis. However, we think that thoracoscopy can be safely used to repair CDH in selected patients and the major limiting factor is pulmonary hypoplasia. Some patients should be excluded based on their higher potential need for patch closure with its technical difficulty and increased operative time. The close collaboration between pediatric surgeon, anesthetist and neonatologist is essential. We discuss here the patient selection criteria, expose the pre- and post-operative management, the procedure steps; regarding to our experience we deliver some tips to achieve the safest surgical procedure for the pediatric patient.