Thoracoscopic repair of congenital diaphragmatic hernia with hernia-ring pin in neonates
10.3760/cma.j.issn.2095-428X.2019.22.013
- VernacularTitle: 胸腔镜下疝环针带线两孔法治疗新生儿先天性膈疝
- Author:
Xiaofeng XIONG
1
;
Wei LU
1
;
Fuzhong XING
1
;
Lei YU
1
;
Yue WANG
1
;
Li GONG
2
;
Yichu CHEN
2
;
Yuji WANG
3
;
Xuyong CHEN
4
Author Information
1. Department of Neonatal Surgery, Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430016, China
2. Department of Cardiothoracic Surgery, Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430016, China
3. Department of Medical Record, Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430016, China
4. the Research Institute at Nationwide Children′s Hospital, Ohio State University, Columbus 43205, U.S.A
- Publication Type:Journal Article
- Keywords:
Thoracoscope;
Infant, newborn;
Diaphragmatic hernia;
Hernia-ring pin
- From:
Chinese Journal of Applied Clinical Pediatrics
2019;34(22):1732-1737
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the indications and outcomes of thoracoscopic repair with hernia-ring pin (TRHP) applied in neonates with congenital diaphragmatic hernia (CDH).
Methods:Fifty-six cases diagnosed as CDH were collected from Department of Neonatal Surgery or Cardiothoracic Surgery in Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science and Technology from May 2013 to September 2018.Patients were divided into thoracoscopic repair (TR) group and TRHP group, and the data, including birth weight, pregnant weeks, ages at operation, hospital stay postoperatively and the number of recurrence cases were compared, between the 2 groups.The size of defect was coded into A, B, C and D grades.Status of patients was grouped into Ⅰ, Ⅱ, Ⅲ, Ⅳ, and Ⅴstages according to the defect size and complicated congenital heart disease.
Results:There were 7 cases in TRHP group, including 3 boys and 4 girls.Four cases belonged to A-class defect and 3 cases were of B-class defect, respectively.The contents of the hernia included small intestine, colon, kidney and spleen.Six cases presented left CDH and 1 case presented right CDH.One of the left CDH cases and the 1 right CDH case had hernia sac.The right CDH neonate presented haematuria in the first day and the second day postoperatively, whose symptom disappeared after treatment.The follow-up time was (12.17±3.41) months, and no recurrent cases were found.All the cases in TRHP group belonged to Ⅰ or Ⅱ stage.There were 49 cases in the TR group.Among them, 29 cases belonged to class-A defect, 18 cases class-B defect, and 4 cases class-C defect, respectively.Cases classified into A and B defects were in stageⅠorⅡ, and cases classified into C defect were in stage Ⅲ.In those 45 cases belonged to A or B defect, 40 cases presented left CDH and 5 case presented right CDH.Among them, 5 neonates had hernia sac.The contents of the hernia included small intestine, colon, kidney and spleen.There were significant differences in the operative time [(83.47±10.28) min vs.(54.29±17.09) min, P<0.05] and length of stay postoperatively [(12.76±5.89) d vs.(7.86±2.03) d, P<0.05] in both groups.TRHP was carried out by the same surgeon, and he also operated on other 18 cases in TR group.Compared with the operative time of cases operated by the same surgeon in both groups, significant diffe-rence was found [(83.47±10.28) min vs.(54.29±17.09) min, P<0.05]. The cases were followed up for (46.17±6.92) months postoperatively and 4 recurrent cases were tracked.One A defect and 1 B defect patients had recurrence 1 month or 2 months postoperatively.Two C defect cases were found to have recurrence postoperatively in 2 months or 6 months, respectively.All 4 cases mentioned above recovered by reoperation.The risk of recurrence in C defect CDH cases existed as high as 21.5 times compared with the A or B defect cases.
Conclusions:It is safe to repair CDH by THRP in neonates with CDH A or B defect, for their operative time may be shorter.TRHP should be highly recommend for CDH cases with A or B defect.
