摘要
目的：对比腔镜手术和开放手术治疗新生儿膈疝的临床疗效,探讨腔镜下治疗新生儿膈疝的可行性及安全性。方法回顾性分析我院2002年6月至2014年2月采取手术治疗的59例新生儿膈疝患儿病例资料。根据手术方式分为腔镜手术组和开放手术组,其中腔镜手术组19例,10例采用胸腔镜,9例采用腹腔镜；开放手术组40例。对比两组患儿的术前资料、手术时及术后恢复情况,比较开放手术与腔镜手术相关并发症、生存率及复发率。结果两组患儿的年龄[（3.4±0.2）d比（4.1±0.5）d,P =0.654]、体质量[（3.3±0.3）kg比（3.5±0.2）kg,P =0.815]基本相同,无统计学差异。与开放组比较,腔镜组住院时间短[（14.2±2.7）d比（21.5±3.5）d,P =0.042],术后通气时间短[（1.8±0.2）d比（5.1±0.9）d,P =0.034],但手术时间长[（115.6±31.2）min 比（92.5±19.4）min,P=0.023]；腔镜组的复发率较高（15.8%比5%,P =0.164）,生存率较低（94.7%比95%,P =0.966）,但差异无统计学意义。近5年腔镜手术组的复发率有所降低,仍较开放组高（9%比5%,P =0.327）,但无统计学差异。结论新生儿膈疝腔镜修补术治疗新生儿膈疝安全有效,其疗效与开放手术相似,且创伤小,术后恢复快,具有较好的美容效果。
Objective To evaluate the outcomes of neonates with congenital diaphragmatic hernia （CDH）undergoing open versus minimally invasive surgery.Methods A total of 59 neonatal CDH cases were recruited from June 2002 to February 2014.They were divided into minimally invasive surgery and open groups.The repair procedures included minimally invasive surgery （n =19）,thoracoscopy （n = 10 ）,laparoscopy （n = 9 ）and open surgery （n = 40 ）.The clinical data including preoperative data,treatment and postoperative management were retrospectively reviewed. The comparisons of clinical data,outcome and recurrence were made between two groups.Results Age [（3.4±0.2）vs （4.1 ±0.5）days,P =0.654]and body weight [（3.3±0.3）vs （3.5±0.2）kg, P =0.81 5]showed no inter-group difference.The overall survival rate of CDH was 94.9%（56/59）. The hospitalization stay [（14.2±2.7）vs （21 .5±3.5）days,P =0.042]and postoperative duration of mechanical ventilation [（1 .8 ± 0.2）vs （5.1 ± 0.9）days,P = 0.034]had significant statistical differences （P 〈 0.05）.The minimally invasive surgery group was significantly shorter than open-group.The operative duration [（1 1 5.6 ±3 1 .2）vs （92.5 ± 19.4）min,P =0.023]was significantly shorter in minimally invasive surgery group than open-group.However the recent 5-year recurrence rate showed no significant statistical differences （9% vs 5%,P =0.327）.Conclusions As compared with open surgery,minimally invasive surgical repair has no increase in the incidence rate of operation-related complications.And the survival rate is comparable for two groups.Thus mini-invasive surgical repair is both safe and efficacious.
出处
《中华小儿外科杂志》
CSCD
北大核心
2014年第8期599-602,共4页
Chinese Journal of Pediatric Surgery
关键词
新生儿
膈疝
腹腔镜
Neonate Diaphragmatic hernia Laparoscopes
