胸腔镜手术治疗新生儿膈疝的临床研究

目的比较新生儿膈疝胸腔镜手术与开腹手术的临床疗效。方法2010年5月至2013年5月我们采取手术治疗23例新生儿膈疝病例。回顾性分析患儿术前准备、手术经过及术后恢复情况，比较开腹手术与胸腔镜手术相关并发症及预后。结果本组膈疝患儿总治愈率86．96％（20／23），其中9例采取胸腔镜手术，1例中转开腹手术；1例实施胸腔镜手术后自动出院，治愈率87．50％（7／8）；15例采取开腹手术，其中2例死亡，治愈13例，治愈率86．67％（13／15），两组比较差异无统计学意义。比较胸腔镜手术和开腹手术两组手术时间、术后抗生素使用时间以及住院时间，差异均有统计学意义（P值均〈0．05）；比较术后24hPCO：、胃肠喂养时间、术后机械通气时间、胸腔积液率及术后胸腔残余气腔率，胸腔镜手术组虽有优势，但差异无统计学意义。20例患儿随访I～37个月，均无复发。结论新生儿胸腔镜膈疝修补术不增加手术相关并发症，且治愈率同开腹手术，提示其手术安全可行。胸腔镜手术时间虽相对延长，但术后抗生素使用时间缩短，住院时间缩短，切口美观。

A comparison of clinical outcome of neonatal diaphragmatic hernia between thoracoscopic repair and laparotomy

Objetive Summarize the clinical outcome of thoracoscopic repair of neonatal congenital dia- phragmatic hernia. Methods 23 neonatal congenital diaphragmatic hernia cases collected from Feb. 2010 to May. 2013. 8 cases were repaired by thoracoscopy and 15 cases were treated by open surgery. Clinical data in- eluding preoperative data, treatments, postoperative management were retrospeetively reviewed. The compari- son of clinical data was made between thoraeoseopie - group and open-group. Outcome and prognoses were eval- uated. Results Cure rate of diaphragmatic hernia was 86.96% in total （20/23）. 9 in thoracoseopic-group, one converted to laparotomy during operation; one auto-discharged after accomplished surgery immediately, cure rate was 87.50% （7/8）. 15 in laparotomy-group, 2 died after surgery, cure rate was 86.67% （13/15）, there＇ s no significant difference between the tow groups. The comparison of the two groups＇the duration of oper- ation, in-hospital time, the time of antibiotics consumption had significant statistic differences （ P 〈 0. 05 ） ; In terms of postoperative PCO2 within 24 h, postoperative time of opening the milks, postoperative duration of me- chanical ventilation, and the incidence of postoperative hydrothorax and pneumothorax, although the thoraco- scopie-group had advantages over the open-group, there were no significant statistic differences. 20 cases had been followed up for 1 ~ 37 months, no recurrence noticed. Conclusion To compare with open surgery, tho- racoseopic repair have no irierease in the incidence rate of operation-related complication. And two groups＇ cure rate is equated. We consider that the thoraeoseopie repair is safe and valid. Although thoracoscopic repair spend more time during operation, it decrease the time of antibiotics consummation and in-hospital time, and in favor of appearance.