Indications for thoracoscopic repair of congenital diaphragmatic hernia in neonates
Indications for thoracoscopic repair of congenital diaphragmatic hernia in neonates
复制标题
胸腔镜新生儿先天性膈疝修补术的适应证
DOI：
10.1007/s00383-010-2724-0
复制
发表时间：
2010
影响因子：
1.8
通讯作者：
A. Yamataka
中科院分区：
文献类型：
--
作者：
T. Okazaki;Kinya Nishimura;Toshiaki Takahashi;H. Shoji;Toshiaki Shimizu;Toshitaka Tanaka;S. Takeda;E. Inada;Geoffrey J. Lane;A. Yamataka
我们回顾了26例先天性腹股沟疝（CDH）前瞻性建立成功的胸腔镜CDH修复术（TR）的选择标准。只有当超声心动图显示肺动脉高压（PH）改善，并且在新生儿重症监护室（NICU）中，在常规机械或高频振荡通气（HFOV）（有/无一氧化氮（NO））下，在卧位心肺状态稳定至少10分钟，作为耐受手术的标志，并且手动通气可以转移到手术室时，才考虑TR。结果21例患者中8例发生TR，13例发生OR。在产前诊断（37.5vs.84.6%，p < 0.05）和出生后早期手术（1.4 ± 0.8vs.2.5 ± 1.1d，p< 0.05）中，TR和OR的差异有统计学意义。所有OR和3例TR均需要术中HFOV（p< 0.01）。1例TR和10例OR均需NO（P< 0.01）。TR的器官疝形成率明显较低（胃为50 vs. 100%，p < 0.01;肝脏为0 vs. 54%，p < 0.05）。3名TR因技术困难而需要改划为OR。一个OR死于PH恶化。结论我们的TR选择标准似乎是安全合理的。
PurposeWe reviewed 26 consecutive cases of congenital diaphragmatic hernia (CDH) prospectively to establish selection criteria for successful thoracoscopic CDH repair (TR).MethodsFive preoperative deaths were excluded, leaving 21 subjects. TR was only considered once pulmonary hypertension (PH) improved on echocardiography, and if cardiopulmonary status was stable in the decubitus position in the neonatal intensive care unit (NICU) under conventional mechanical or high-frequency oscillatory ventilation (HFOV) with/without nitric oxide (NO) for at least 10 min as a marker for tolerating surgery and manual ventilation was possible for transfer to the operating room. All other patients had open repair (OR).Results8/21 had TR and 13/21 had OR. There were significant differences between TR and OR for prenatal diagnosis (37.5 vs. 84.6%,p< 0.05) and earlier surgery (1.4 ± 0.8 vs. 2.5 ±1.1 days after birth,p< 0.05), respectively. Intraoperative HFOV was required in all OR and 3 TR (p< 0.01). NO was required in 1 TR and 10 OR (p< 0.01). Organ herniation was significantly less in TR (50 vs. 100%,p< 0.01 for stomach; 0 vs. 54%,p< 0.05 for liver). Three TR required conversion to OR because of technical difficulties. One OR died from deteriorating PH.ConclusionsOur selection criteria for TR would appear to be safe and reasonable.