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1.
Jeffrey W. Gander Jason C. Fisher Ari R. Reichstein Gudrun Aspelund Keith A. Kuenzler 《Journal of pediatric surgery》2011,46(7):1303-1308
Introduction
Experience in thoracoscopic congenital diaphragmatic hernia (CDH) repair has expanded, yet efficacy equal to that of open repair has not been demonstrated. In spite of reports suggesting higher recurrent hernia rates after thoracoscopic repair, this approach has widely been adopted into practice. We report a large, single institutional experience with thoracoscopic CDH repair with special attention to recurrent hernia rates.Methods
We reviewed the records of neonates with unilateral CDH repaired between January 2006 and February 2010 at Morgan Stanley Children's Hospital. Completely thoracoscopic repairs were compared to open repairs of the same period. In addition, successful thoracoscopic repairs were compared with thoracoscopic repairs that developed recurrence. Data were analyzed by Mann-Whitney U and Fisher exact tests.Results
Thirty-five neonates underwent attempted thoracoscopic repair, with 26 completed. Concurrently, 19 initially open CDH repairs were performed. Preoperatively, patients in the open repair group required more ventilatory support than the thoracoscopic group. Recurrence was higher after thoracoscopic repair (23% vs 0%; P = .032). In comparing successful thoracoscopic repairs to those with recurrence, none of the factors analyzed were predictive of recurrence.Conclusions
Early recurrence of hernia is higher in thoracoscopic CDH repairs than in open repairs. Technical factors and a steep learning curve for thoracoscopy may account for the higher recurrence rates, but not patient severity of illness. In an already-tenuous patient population, performing the repair thoracoscopically with a higher risk of recurrence may not be advantageous. 相似文献2.
目的探究胸腔镜治疗新生儿先天性膈疝(CDH)的围手术期监护护理效果。
方法选取2010年1月至2018年10月,首都医科大学附属北京潞河医院就诊的64例先天性膈疝患儿,随机分为综合护理组(32例)和常规护理组(32例),常规护理组给予围手术期常规护理,综合护理组则在此基础上给予综合护理。分别观测并比较2组患儿的围手术期指标、血气分析指标、舒适度、依从性以及护理质量评分和术后并发症发生情况。
结果综合护理组患儿的手术时间、术中出血量分别为(114.29±11.54)min、(2.58±1.01)ml与常规护理组(116.83±12.73)min、(2.81±1.03)ml比较,差异无统计学意义(t=0.862、0.900,P=0.392、0.356);综合护理组住院时间、术后机械通气时间(12.18±4.11)d、(2.04±1.17)d均低于常规护理组(17.52±5.25)d、(2.89±2.03)d,差异均有统计学意义(t=4.670、2.115,P<0.001、=0.038)。2组患儿血气指标在术前、气腹后10 min、放气后30 min 3个时间点组间比较,差异均无统计学意义(P>0.05)。气腹后10 min与术前比较,2组患儿组内PaCO2、气道峰压、呼气末CO2分压均增加,差异均有统计学意义(P<0.05);放气后30 min与术前比较,2组患儿的PaCO2、气道峰压、呼气末CO2分压均差异无统计学意义(P>0.05)。综合护理组患儿的舒适度、依从性和护理质量评分分别为(91.05±10.22)分、(91.48±7.64)分和(93.11±10.08)分均高于常规护理组(81.69±9.81)分、(80.27±7.05)分和(80.97±8.19)分,差异均有统计学意义(t=3.853、6.288、5.450,P均<0.001)。综合护理组术后并发症的发生率(3.125%)低于常规护理组(21.875%),差异有统计学意义(χ2=5.143,P=0.023)。
结论综合护理干预在胸腔镜膈疝修补术治疗新生儿CDH中具有重要作用,可明显缩短患儿术后恢复时间,使血气指标维持正常平稳,有效降低术后并发症的发生率,显著提高患儿的舒适度、依从性和护理满意度,值得临床推广。 相似文献
3.
Purpose
To describe the surgical technique, initial results, and overview indications of thoracoscopic repair of congenital diaphragmatic hernia (CDH).Materials and Methods
A retrospective review was undertaken of patients with CDH who underwent thoracoscopic repair by the same surgeon from January 2001 to January 2005. Patients underwent surgery under general anesthesia. Reduction of the hernia contents was carried out using 1 optical trocar and 2 operating trocars. Pleural insufflation with carbon dioxide was maintained at a pressure of 2 to 4 mm Hg. The hernia defect was repaired using nonabsorbable interrupted sutures with extracorporeal knots.Results
There were 45 patients, including 29 boys and 16 girls. Among 19 newborn patients, there were 13 patients younger than 7 days. The other 26 patients were infants and elders. The hernia was located in the left side in 37 patients and in the right side in 8 patients. The mean operative time was 54 minutes. Conversion was required in 4 patients. There were no complications. However, there were 2 postoperative deaths.Conclusions
Thoracoscopic repair is feasible and safe for children with CDH, including selective newborn. The technique causes minimal trauma, results in good respiratory function, and promotes early recovery. 相似文献4.
Tsao K Lally PA Lally KP;Congenital Diaphragmatic Hernia Study Group 《Journal of pediatric surgery》2011,46(6):1158-1164
Purpose
Operative approach, including minimally invasive surgery (MIS) in the repair of congenital diaphragmatic hernia (CDH), is variable among institutions. The short-term recurrent hernia rate is not well described. We evaluated the in-hospital recurrence rate of MIS repairs of infants with CDH from the Congenital Diaphragmatic Hernia Registry.Methods
Prospectively collected data from infants with CDH were analyzed from the Congenital Diaphragmatic Hernia Registry from January 1995 to January 2010. Recurrent hernia was defined as reoperations during initial hospitalization. Operative approaches included abdominal, thoracic, laparoscopic, and thoracoscopic techniques.Results
Five thousand four hundred eighty infants with CDH were identified, of which 4516 (82.4%) were repaired. Operative data were available in 4390 infants. One hundred fifty-one infants (3.4%) underwent MIS repairs with 12 reported recurrences (7.9%) compared with 114 for open techniques (2.7%, P < .05). Minimally invasive surgery demonstrated a significant increased odds for recurrence (odds ratio, 3.59; 95% confidence interval, 1.92-6.71) after adjusting for gestational age, birth weight, patch repair, and extracorporeal membrane oxygenation.Conclusion
Minimally invasive techniques appear to have a significant higher recurrent hernia rate, with thoracoscopy being the highest. Although adjusted for patch repair, other factors with regard to disease severity may contribute to differences in outcomes among centers. This study is limited to short-term recurrence during initial hospitalization. 相似文献5.
Patrick T. Delaplain Matthew T. Harting Tim Jancelewicz Lishi Zhang Peter T. Yu Matteo Di Nardo Yanjun Chen James E. Stein Henri R. Ford Danh V. Nguyen Yigit Guner 《Journal of pediatric surgery》2019,54(6):1132-1137
PurposeStudying the timing of repair in CDH is prone to confounding factors, including variability in disease severity and management. We hypothesized that delaying repair until post-ECMO would confer a survival benefit.MethodsNeonates who underwent CDH repair were identified within the ELSO Registry. Patients were then divided into on-ECMO versus post-ECMO repair. Patients were 1:1 matched for severity based on pre-ECMO covariates using the propensity score (PS) for the timing of repair. Outcomes examined included mortality and severe neurologic injury (SNI).ResultsAfter matching, 2,224 infants were included. On-ECMO repair was associated with greater than 3-fold higher odds of mortality (OR 3.41, 95% CI: 2.84–4.09, p < 0.01). The odds of SNI was also higher for on-ECMO repair (OR 1.49, 95% CI: 1.13–1.96, p < 0.01). A sensitivity analysis was performed by including the length of ECMO as an additional matching variable. On-ECMO repair was still associated with higher odds of mortality (OR 2.38, 95% CI: 1.96–2.89, p < 0.01). Results for SNI were similar but were no longer statistically significant (OR 1.33, 95% CI: 0.99–1.79, p = 0.06).ConclusionsOf the infants who can be liberated from ECMO and undergo CDH repair, there is a potential survival benefit for delaying CDH repair until after decannulation.Type of StudyTreatment StudyLevel of EvidenceIII 相似文献
6.
Richard Keijzer Cees van de Ven John Vlot Cornelius Sloots Gerard Madern Dick Tibboel Klaas Bax 《Journal of pediatric surgery》2010,45(5):953-957
Purpose
Congenital diaphragmatic hernia (CDH) has traditionally been repaired via a laparotomy. More and more reports on thoracoscopic repair are being published. The aim of this study was to evaluate our series of thoracoscopic CDH repair and compare this group to an open repair group treated during the same period in the same institute.Patients and Methods
Between June 2006 and December 2008, 49 children with posterolateral CDH were admitted, of whom 23 (47%) were operated thoracoscopically and 23 (47%) using an open repair, depending on the discretion of the attending surgeon and the clinical condition of the patient. Three patients (6%) with CDH were not treated because of associated anomalies (twice Cornelia de Lange syndrome and once hypoplastic left heart syndrome). Six thoracoscopic operations (26%) were converted to open surgery. Nine defects (39%) were closed thoracoscopically without a patch. In 8 (35%) patients, a patch was used. We used a patch in 20 open procedures (87%).Results
Three (33%) of the 9 thoracoscopic repairs without patch and 1 (12%) of the 8 with a patch developed a recurrence. All these recurrences were repaired thoracoscopically. The 3 recurrences from the thoracoscopic primary repair were repaired using a patch. In the open group, 3 patients (13%) developed a recurrence, of whom 2 were repaired thoracoscopically.Mean operative time was significantly longer in the thoracoscopic patch repair group (158 minutes), when compared to the open repair group (125 minutes).Conclusion
As in open repair, it seems wise to use large patches liberally, not only to reconstruct the dome of the diaphragm but also to avoid undue tension on the repair and prevent recurrences. The thoracoscopic approach is also considered feasible in case of a recurrence from either a thoracoscopic or open repair. 相似文献7.
Raquel Gonzalez 《Journal of pediatric surgery》2009,44(6):1181-1185
Purpose
Chylothorax after congenital diaphragmatic hernia (CDH) repair contributes significantly to morbidity. Our aim was to identify factors contributing to chylothorax and effective treatment strategies.Methods
We reviewed 171 patients with CDH from 1997 to 2008 and analyzed hernia characteristics, extracorporeal membrane oxygenation (ECMO) use, operative details, and treatment approaches for chylothorax.Results
Ten (7%) patients developed chylothorax; all were left sided. Using univariate analysis, prenatal diagnosis, ECMO use, and patch repair were associated with development of chylothorax. Logistic regression analysis showed that patch repair was the only variable predictive of chylothorax (P = .028; confidence interval, 0.032-0.823). Although survival was not affected, patients with chylothorax had a significant increase in ventilator days and length of stay (t = 3.57; P = .000; t = 2.74; P = .007). All received thoracostomy and total parenteral nutrition. Six patients received octreotide, 5 of whom required pleurectomy because of failed medical management; the remaining patient died of overwhelming sepsis.Conclusions
The incidence of chylothorax at our institution was relatively low. Patch repair was associated with the formation of chylothorax. Morbidity was substantial, but survival was not significantly affected. Total parenteral nutrition and thoracostomy were appropriate initial treatments. Octreotide was not an effective adjunct. Refractory cases were successfully treated with pleurectomy. 相似文献8.
Sohail R. Shah George K. Gittes Katherine A. Barsness Timothy D. Kane 《Surgical endoscopy》2009,23(1):215-215
Purpose Minimally invasive techniques continue to expand in pediatric surgery; however, there has been some debate over the appropriate
operative technique for the management of congenital diaphragmatic hernias in neonates [1–3]. We present a video of a thoracoscopic patch repair of a right-sided Bochdalek congenital diaphragmatic hernia (CDH) in
a 3-day-old male.
Methods Our patient was noted to have a right-sided CDH on chest X-ray following respiratory distress at the time of birth. The patient’s
remaining neonatal workup also confirmed hypoplastic transverse aortic arch with coarctation, ventricular septal defect (VSD),
and patent ductus arteriosus, which were initially diagnosed by prenatal ultrasound. After monitoring the patient for hemodynamic
stability and discussion with the family and involved pediatric cardiothoracic surgeons, the decision was made to proceed
with a thoracoscopic repair of the CDH.
Results The large right-sided CDH was noted to involve herniated small bowel, colon, and liver. The diaphragmatic defect was successfully
repaired thoracoscopically using a 5 × 5 cm polytetrafluoroethylene (PTFE) patch. The patient was extubated on the second
postoperative day and ultimately underwent aortic arch augmentation, VSD closure, and patent ductus arteriosus ligation and
division at 1 month of age. There has been no evidence of CDH recurrence in follow-up.
Conclusions As demonstrated by our video, large right-sided congenital diaphragmatic hernias requiring patch repair can be successfully
repaired thoracoscopically with appropriate surgeon comfort and experience. This minimally invasive approach may also be used
in neonates with associated cardiac defects with appropriate cardiothoracic surgical consultation and support. To our knowledge
this is the first reported case of a thoracoscopic repair of a Bochdalek (posterolateral) hernia with a prosthetic patch in
a neonate with significant congenital cardiac anomalies.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. 相似文献
9.
Purpose
Many different prosthetic materials have been used for repair of large posterolateral congenital diaphragmatic hernias (CDH), with high recurrence rates for hernias that cannot be primarily repaired. Since 1993, we have used a composite patch of Gore-Tex/Marlex to repair large CDHs and hypothesized that this repair leads to fewer recurrences.Methods
This is a retrospective review of 137 consecutive patients with CDH cared for at a single institution from 1993 to 2004. Data collected include timing and method of repair and use of extracorporeal membrane oxygenation. Outcomes include hernia recurrence, complications, and death.Results
One hundred thirty-seven patients with CDH were analyzed. Repair was not attempted in 12 because of disease severity. Primary repair was accomplished in 79 and 46 required patch repair. Of the 46 patients with patch repairs, 32 required extracorporeal membrane oxygenation, and 18 died before discharge. Of the 28 patch repair survivors, 1 (3.57%) developed a recurrence over a median follow-up of 47 months (range, 2-115 months). Overall survival was 77%.Conclusions
Gore-Tex/Marlex composite patch repair of large CDHs in this complex patient population results in a lower recurrence rate than has been reported for other types of prosthetic diaphragm repair. 相似文献10.
Tim Jancelewicz Elizabeth A. Paton Jorie Jones Mark F. Weems Pamela A. Lally Max R. Langham Jr. 《Journal of pediatric surgery》2019,54(5):932-936
BackgroundManagement of CDH is highly variable from center to center, as are patient outcomes. The purpose of this study was to examine risk-stratified survival and extracorporeal membrane oxygenation (ECMO) rates at a single center, and to determine whether adverse outcomes are related to patient characteristics or management.MethodsA retrospective single-center review of CDH patients was performed, and outcomes compared to those reported by the CDH Study Group (CDHSG) registry. Patient demographics, disparities, and clinical characteristics were examined to identify unique features of the cohort. A model derived using the registry that estimates probability of ECMO use or death in CDH newborns was used to risk-stratify patients and assess mortality rates. Observed over expected (O/E) ECMO use rates were calculated to measure whether “excess” or “appropriate” ECMO use was occurring.ResultsThere were 81 CDH patients treated between 2004–2017, and 5034 in the CDHSG registry. Mortality in ECMO-treated patients was higher than the registry. Socioeconomic variables were not significantly associated with outcomes. The strongest predictors of mortality were ECMO use and early blood gas variables. The risk model accurately predicted ECMO use with a c-statistic of 0.79. Compared with the registry, the disparity in mortality rates was greatest for moderate-risk patients. O/E ECMO use was highest in low and moderate-risk patients.ConclusionsECMO use is a more consistent predictor of mortality than CDH severity at a single center, and there is relative overuse of ECMO in lower-risk patients. Risk stratification allows for more accurate institutional assessment of mortality and ECMO use, and other centers could consider such an adjusted analysis to identify opportunities for outcomes improvement.Level of EvidenceIII. 相似文献
11.
Sameh M. Said 《Journal of pediatric surgery》2010,45(4):e5
Congenital diaphragmatic hernia (CDH) occurs in 1 of every 2000 to 3000 live births and accounts for 8% of all major congenital anomalies. Bilateral hernias account for no more than 1% of all types of CDH; furthermore, they are usually fatal prenatally. Those that survive are identified through a limited number of case reports. We are presenting an unusual case of bilateral CDH hernia in a neonate that was repaired successfully using a staged thoracoscopic approach. To our knowledge, this represents the first case in the world literature of bilateral CDH that was repaired thoracoscopically. In carefully selected patients, appropriate use of disruptive new technologies such as thoracoscopy can be achieved. 相似文献
12.
目的探讨允许性高碳酸血症(PHC)在新生儿胸腔镜先天性膈疝修补术中的应用效果。方法择期行胸腔镜先天性膈疝修补术的新生儿60例,ASAⅡ或Ⅲ级,男37例,女23例,出生1~28d。随机均分为PHC组(P组)和对照组(C组)。两组患儿气管插管完成后先双肺通气(TLV),左侧膈疝取右侧卧位,右侧膈疝取左侧卧位,手术开始,待手术侧人工气胸(压力为6mm Hg)建立后,由术者在镜下手术操作同时用钝性胸腔镜器械(如钝头分离钳等)适当推移压迫术侧肺,使之萎陷,以实施对侧单肺通气(OLV),便于术野暴露。P组OLV初设VT6ml/kg、RR 30~40次/分、I∶E 1∶1.5~2、PEEP 4~5cm H2O、FiO2100%、新鲜气流量2L/min、Pmax 30cm H2O,术中根据气道压和动脉血气分析结果,调整RR、PEEP,维持PaCO280mm Hg。C组OLV初设VT10ml/kg,其它呼吸参数同P组,调整RR、PEEP,维持PaCO235~45mm Hg。分别于TLV 30min(T0)、OLV 30min(T1)、OLV 60min(T2)、OLV 90min(T3)、恢复TLV 15min(T4)动脉采血并即行血气分析,术后继续相同模式机械通气,术后2h记录有无气胸发生,记录术毕至撤离呼吸机时间和术后住院时间。结果 T1~T3时P组患儿动脉血pH值明显低于C组,PaCO2明显高于C组(P0.05)。T1~T4时两组患儿PaO2差异无统计学意义。P组气胸发生率(13.3%)明显低于C组(36.7%)(P0.05)。两组患儿术毕至撤离呼吸机时间和术后住院时间差异均无统计学意义。结论PHC(PaCO280mm Hg)通气用于新生儿胸腔镜先天性膈疝修补术可明显降低气胸发生率,且对术中PaO2、术后机械通气时间和术后住院时间均无明显影响。 相似文献
13.
Cory N. Criss Megan A Coughlin Niki Matusko Samir K. Gadepalli 《Journal of pediatric surgery》2018,53(4):635-639
Introduction
Indications for thoracoscopic versus open approaches to repair congenital diaphragmatic hernia (CDH) are unclear as the variability in defect size, disease severity and patient characteristics pose a challenge. Few studies use a patient and disease-matched comparison of techniques. We aimed to compare the clinical outcomes of open versus thoracoscopic repairs of small to moderate sized hernia defects in a low risk population.Methods
All neonates receiving CDH repair of small (type A) and moderate (type B) size defects at an academic children's hospital between 2006 and 2016 were retrospectively reviewed and analyzed. Patients < 36 weeks gestation, birth weight < 1500 g, or requiring extracorporeal life support were excluded. Demographics, including CDH severity index, and hernia characteristics were recorded. The primary outcome parameter was recurrence. Secondary outcomes included length of hospital stay, length of mechanical ventilation, time to goal feeds, and mortality.Results
The 51 patients receiving thoracoscopic (35) and open (16) repairs were similar in patient and hernia characteristics, with median 2-year follow-up for both groups. Patients with thoracoscopic repair had shorter hospital stay (16 vs. 23 days, p = 0.03), days on ventilator (5 vs. 12, p = 0.02), days to start of enteral feeds (5 vs. 10, p < 0.001), and days to goal feeds (11 vs. 20, p = 0.006). Higher recurrence rates in the thoracoscopic groups (17.1% vs. 6.3%) were not statistically significant (p = 0.28). Median time to recurrence was 88 days for the open repair and 183 days (IQR 165–218) for the thoracoscopic group. There were no mortalities in either group.Conclusions
In low risk patients born with small to moderate size defects, a thoracoscopic approach was associated with decreased hospital length of stay, mechanical ventilation days, and time to feeding; however, there was a trend towards higher recurrence rates.Level of evidence
Level III. 相似文献14.
目的 探索先天性膈疝(CDH)患儿胸腔镜术后30 d死亡的危险因素,并构建列线图风险预测模型。方法 选择2020年6月至2023年6月接受胸腔镜膈疝修补术的CDH患儿90例,男62例,女28例,手术时日龄<28 d。根据术后30 d是否存活分为两组:生存组与死亡组。采用差异性分析、单因素Logistic回归进行预测因子筛选,采用多因素Logistic回归分析CDH胸腔镜术后30d死亡的危险因素,构建术后30 d死亡风险列线图预测模型,采用ROC曲线、Bootstrap法、决策曲线分析该模型的预测效能、校准度以及决策能力。结果 有28例(31%)CDH患儿在胸腔镜下膈疝修补术后30 d死亡。多因素Logistic回归分析显示:产前诊断时间≤25周、低体重儿、术前高频振荡通气(HFOV)、术前氧合指数(OI)增加、开腹手术、肝脏疝入胸腔是CDH患儿术后30 d死亡的独立危险因素(P<0.05)。基于上述独立危险因素构建CDH患儿术后30 d死亡风险的列线图预测模型,结果显示,该模型AUC为0.959(95%CI 0.9107~1.0000),当截断值为0.361时,敏感性为92... 相似文献
15.
Traumatic diaphragmatic hernia is very rare in children, and the diagnosis is often missed or delayed. Herein, we reported a 2-year-old boy who had suffered with traumatic diaphragmatic hernia due to a car crash. The child was manifested as tachypnoea without any other severe symptoms. The computed tomography scanning showed his right diaphragm was rupture. Soon, this patient was received a thoracoscopic repair surgery, and he was discharged 2 weeks later without any complication. 相似文献
16.
Jason C. Fisher Mary Jo Haley Alejandro Ruiz-Elizalde Charles J.H. Stolar Marc S. Arkovitz 《Journal of pediatric surgery》2009,44(6):1173-1180
Purpose
Risk factors that predispose children with congenital diaphragmatic hernia (CDH) to recurrence remain poorly defined. We report a large series of recurrent CDH and ask whether prenatal patient factors or postnatal treatment variables better predict recurrence.Methods
Two hundred thirty-eight neonates with unilateral CDH underwent repair from 1990 to 2006. Data were assessed by χ2 and Mann-Whitney U tests. Multivariate regression identified independent predictors of recurrence. Statistical significance was set at P < .05.Results
We identified 24 recurrences (10%). Median time from repair to recurrence diagnosis was 4.9 months. Patients with recurrence were older (P = .02) and more often required abdominal wall patches at initial repair (P = .01) compared to nonrecurrence patients. Postoperative length of stay (LOS) after initial repair (P < .01) and morbidity (P = .01) were greater in recurrence patients. Use of diaphragm patch at initial repair was greater in patients with recurrence but only approached statistical significance (P = .05). Only 2 variables independently predicted recurrence by multivariate regression as follows: abdominal (not diaphragm) wall patch during initial repair (odds ratio [OR] 3.50; P = .04) and postoperative LOS (OR, 1.012; P = .01).Conclusion
Neonates at risk for CDH recurrence are better identified by postnatal treatment variables than by prenatal patient factors. Although age at repair and diaphragm patch use are greater in recurrence patients, the only factors to independently predict recurrence were postoperative LOS and abdominal wall patch use. These data can help optimize follow-up regimens. 相似文献17.
This report describes the laparoscopic approach of closure of a congenital left posterolateral diaphragmatic hernia in a 6-month-old boy. The pros and cons of such an approach are discussed. 相似文献
18.
Background
Diaphragmatic hernia can be repaired by open or minimally invasive surgery (MIS), although it is unclear which technique has better outcomes. Our objective was to compare the outcomes of these procedures in a systematic review and meta-analysis.Methods
We sought all publications describing both techniques through MEDLINE, Embase, and CENTRAL. Our primary outcome of interest was recurrence. We conducted statistical analyses using Review Manager 5.2.Results
We did not identify any randomized controlled trials. Our pooled estimate of results from 10 studies showed that total recurrence was higher after MIS (OR: 2.81 [1.73, 4.56], p < 0.001). Subgroup analyses indicated higher recurrence after MIS for patch repairs (OR: 4.29 [2.13, 8.67], p < 0.001), but not for primary repairs. Operative time was longer for MIS (MD: 55.25 [40.21, 70.28], p < 0.001), while postoperative ventilator time and postoperative mortality were higher after open surgery (MD: 1.33 [0.05, 2.62], p = 0.04; OR: 7.54 [3.36, 16.90], p < 0.001, respectively).Conclusions
Recurrence rate is higher after MIS than open repair when a patch is used. Operative time is also longer with MIS. Poorer outcomes after open surgery may be a result of selection bias rather than surgical technique. Surgeons should carefully consider the potential morbidity associated with MIS when deciding on a repair method. 相似文献19.
David M. Gourlay Laura D. Cassidy Thomas T. Sato Dave R. Lal Marjorie J. Arca 《Journal of pediatric surgery》2009,44(9):1702-879
Background
Although both laparoscopic and thoracoscopic repair of congenital diaphragmatic hernia (CDH) have been described in the literature, neither appropriate selection criteria nor improved outcomes for minimally invasive repair over open repair have been clearly delineated.Methods
We reviewed our experience with neonatal CDH repair between 2004 and 2007 to determine clinical parameters that are associated with successful thoracoscopic CDH repair. We compared these patients to a similarly matched cohort of patients who had undergone an open neonatal CDH repair between 1999 and 2003.Results
From 2004 to 2007, 20 (61%) of 33 patients underwent successful neonatal thoracoscopic CDH repair. Characteristics common to all patients who underwent successful thoracoscopic repair included absence of congenital heart defects, no need for extracorporeal membrane oxygenation, ventilatory peak inspiratory pressure of less than 26 cmH2O, and oxygenation index less than 5 on the day of planned surgery. From 1999 to 2003, 40 patients underwent an open neonatal CDH repair, of which 18 (45%) patients would have matched our selection criteria for thoracoscopic repair. These 2 cohorts were similar in age, estimated gestational age, weight, APGAR scores, and oxygenation index at the time of surgery. The thoracoscopic cohort had statistically and clinically significant quicker return to full enteral feeds, had shorter duration on the ventilator postoperatively, and required less narcotic/sedation postoperatively. Less severe complications occurred in the thoracoscopic cohort. Adjusted total hospital charges were less for the thoracoscopic repair.Conclusions
Successful thoracoscopic CDH repair can be expected in newborns, which has limited respiratory compromise. Thoracoscopic CDH repair is associated with lower morbidity and quicker recovery than traditional open repair and without increased risk of recurrence or complications. 相似文献20.