全胸腔镜手术治疗婴幼儿先天性膈疝的临床研究

目的 探讨全胸腔镜手术治疗婴幼儿先天性膈疝的临床效果以及安全性、可行性。方法 回顾性研究。纳入2015年4月—2021年3月南京医科大学附属儿童医院小儿心胸外科97例先天性膈疝患儿的临床资料。其中男61例、女36例,年龄2 d~3岁（3.1 ± 7.2）个月];左侧51例,右侧46例。所有患儿均在胸腔镜下行膈疝修补术,术中观察疝内容物有无坏死、穿孔、损伤等情况,记录胸腔镜手术患儿的手术时间、术中出血量、术后胸腔引流量、引流管拔除时间、手术后住院时间。术后定期随访,观察切口感染、膈膨升、乳糜胸、气胸、肠梗阻等相关并发症发生情况,以及术后膈疝复发情况。结果 97例患儿均在全胸腔镜下顺利完成手术,无一例中转开胸手术。术中见疝囊内容物多为脾脏、胃、大网膜、结肠、小肠等,无肠穿孔坏死、肝脾出血等情况发生。手术时间75~150（90.5 ± 12.1） min,手术出血量6~15（8.3 ± 0.6） mL,术后胸腔引流量30~130（41.2 ± 7.6） mL,引流管拔除时间3~10（6.1 ± 1.3） d,手术后住院时间10~18（11.7 ± 2.1） d。住院期间因缝线脱落导致复发2例,再次行胸腔镜手术治愈;1例患儿术后第1天因左肺严重发育不良死亡。术后96例患儿均获随访,随访时间1个月~3年,平均9.2个月。随访期间无切口感染、乳糜胸、呼吸道感染、肠梗阻、肠穿孔等并发症发生,患儿生长发育良好,无一例复发。结论 全胸腔镜手术治疗婴幼儿先天性膈疝具有手术视野暴露清楚、术中出血量少、术后并发症少、住院时间短等优点,短期疗效可靠,安全可行。

Clinical study on the complete thoracoscopy of congenital diaphragmatic in infants

Objective To explore the safety, feasibility, and clinical effects of thoracoscopic surgery for congenital diaphragmatic hernia and to summarize the surgical experience. Methods The clinical data of 97 child patients with congenital diaphragmatic hernia obtained from the Department of Pediatric Cardiothoracic Surgery of the Children's Hospital of Nanjing Medical University from April 2015 to March 2021 were retrospectively analyzed. The patients, aged 2 days to 3 years (3.1 ± 7.2] months), consisted of 61 males and 36 females, and 51 cases were left side, and 46 cases were right side. All children underwent diaphragmatic hernia repair under thoracoscopy. During the operation, the contents of the hernia were observed for necrosis, perforation, and injury, and the time of operation, intraoperative blood loss, postoperative thoracic drainage, drainage tube removal time, and hospital stay time after surgery were recorded. Regular follow-up after operation was performed, and the occurrence of related complications, such as incision infection, diaphragm expansion, chylothorax, pneumothorax, intestinal obstruction, and diaphragmatic hernia recurrence after operation were recorded. Results Thoracoscopic surgery was successfully performed in all patients, and none of them switched to traditional surgery. During the operation, the contents of the hernia sac were mostly spleen, stomach, omentum majus, colon, and small intestine, and intestinal perforation, necrosis, liver, and spleen hemorrhage did not occur. The operation time was 75–150 (90.5 ± 12.1) min, the surgical blood loss was 6–15 (8.3 ± 0.6) mL, postoperative thoracic drainage volume was 30–130 (41.2 ± 7.6) mL, drainage tube removal time was 3–10 (6.1 ± 1.3) d, hospital stay after surgery was 10–18 (11.7 ± 2.1) d. During hospitalization, two cases recurred because of the loss of sutures and thus subjected to thoracoscopic surgery again. One case died of severe dysplasia of the left lung on the first postoperative day. A total of 96 child patients were followed up after the operation. The follow-up time ranged from 1 month to 3 years, with an average of 9.2 months. During the follow-up period, no incision infection, chylothorax, respiratory tract infection, intestinal obstruction, and intestinal perforation were observed. The children grew well and did not suffer a recurrence. Conclusions Total thoracoscopic surgery for the treatment of congenital diaphragmatic hernia in infants has the following advantages: clear surgical field of vision, decreased blood loss during operation, decreased postoperative complications, and short hospital stay. The short-term curative effect is reliable, safe, and feasible.