CAJ | 학술논문

目的探讨婴幼儿膈膨升症的临床特点、诊断及不同手术路径和术式的选择.方法本文回顾性分析2008年11月至2013年4月我院小儿外科收治的膈膨升患儿24例临床资料,男女比例3∶1,年龄范围2个月至3岁,其中右侧膈膨升20例,左侧膈膨升4例,22例行胸腔镜下膈肌折叠术,2例行腹腔镜下膈肌折叠术.共采用3种不同腔镜下膈肌折叠术式,门诊随访时间2～35个月.结果 24例患儿手术均在胸腔镜下或腹腔镜下顺利完成,无中转开胸或中转开腹病例,无术中并发症,术后复查胸片提示膈肌较术前下降1～4.5个肋间隙(平均2.7个肋间隙),术后3个月门诊复查胸片提示横膈有轻微再升高现象,但均在1个肋间隙范围内.结论微创手术治疗膈膨升安全有效,具有创伤小,恢复快,治疗效果满意等优点,外科医生应根据临床经验、操作技能及手术室条件选择合理的手术路径及术式.
목적 탐토영유인격팽승증적림상특점、진단급불동수술로경화술식적선택.방법 본문회고성분석2008년11월지2013년4월아원소인외과수치적격팽승환인24례림상자료,남녀비례3∶1,년령범위2개월지3세,기중우측격팽승20례,좌측격팽승4례,22례행흉강경하격기절첩술,2례행복강경하격기절첩술.공채용3충불동강경하격기절첩술식,문진수방시간2～35개월.결과 24례환인수술균재흉강경하혹복강경하순리완성,무중전개흉혹중전개복병례,무술중병발증,술후복사흉편제시격기교술전하강1～4.5개륵간극(평균2.7개륵간극),술후3개월문진복사흉편제시횡격유경미재승고현상,단균재1개륵간극범위내.결론 미창수술치료격팽승안전유효,구유창상소,회복쾌,치료효과만의등우점,외과의생응근거림상경험、조작기능급수술실조건선택합리적수술로경급술식.
Objective To discuss the clinical feature,diagnosis and surgical management for infants with diaphragmatic eventration.Methods This study retrospectively analyzed the clinical data of patients with diaphragmatic eventration during November 2008 to April 2013.The male to female ratio was 3 ∶1,with age at presentation ranged from 3 months to 3 years.Twenty of them had right-sided eventration,4 had left-sided eventration.Twenty-two patients were repaired thoracoscopically while the other 2 patients had laparoscopic approach.Three different plication techniques were used.Follow-up time ranged from 2 to 35 months.Results All patients successfully underwent minimally invasive surgery with no conversion.Post-operatively,the diaphragm descended between 1 to 4.5 intercostal spaces (mean distance of 2.7 intercostal spaces).During 3-month follow up,chest radiographs showed only a slight rise of the diaphragm within one intercostal space.Conclusions Minimally invasive surgery to treat diaphragmatic eventration is feasible and has significant advantages such as little trauma,quick recovery,and parental satisfaction.