危重症先天性膈疝手术时机选择

目的 探讨危重症先天性膈疝最佳手术时机选择,提高手术治愈率。方法 回顾性分析了开封市儿童医院2008年7月至2016年12月间收治的危重症先天性膈疝病人的临床资料共20例,总结归纳了其围手术时期的处理方法以及手术时机。其中4例病儿合并其他畸形,家长放弃治疗。16例病人根据手术时期分成延期手术组、紧急手术组。比较不同组的临床转归情况。结果 危重症先天性膈疝病儿16例中,手术总体治愈率为62.5%(10/16),病死率为37.5%(6/16),延期手术治愈率88.89%(8/9)、紧急手术治愈率28.57%(2/7),延期手术组与紧急手术组比较差异有统计学意义(P=0.035),术后经过6个月随访,存活的10例病儿没有并发症发生。结论 对于危重先天性膈疝,延期手术能够明显提高病儿存活率。

Timing of surgery for critical congenital diaphragmatic hernia

Objective To explore the optimal surgery timing for critical congenital diaphragmatic hernia,and to improve the cure rate of the operation.Methods Data of 20 cases of critical congenital diaphragmatic hernia admitted to Children''s Hospital of Kaifeng from July 2008 to December 2016 were retrospectively analyzed,and the treatment in perioperative period and the timing of surgery were summarized.Four cases were combined with other malformation,and their parents gave up their treatment.The other 16 cases were assigned into postponed surgery group and emergency surgery group according to the surgery timing,and the clinical outcomes were compared between the two groups.Results Of the 16 cases of critical congenital diaphragmatic hernia,the total cure rate was 62.5% (10/16),the death rate was 37.5% (6/16).The cure rates in postponed surgery group and emergency surgery group were 88.89% (8/9) and 28.57% (2/7) respectively,and the difference was statistically significant (P=0.035).Six-month postoperative follow-up found no complication in the 10 cases of survival.Conclusion Postponed surgery can significantly improve the survival rate of children with the critical congenital diaphragmatic hernia.