CAJ | 학술논문

目的：探讨胸腔镜手术治疗新生儿先天性膈疝（ congenital diaphragmatic hernia ，CDH）的疗效。方法2013年9月～2014年8月应用胸腔镜治疗新生儿先天性膈疝14例，观察孔位于肩胛下角第6肋间，置入5 mm trocar ，操作孔2个，分别位于肩胛下角线与脊柱连线中点第5～7肋间和腋前线第5～7肋间，置入3 mm trocar；在6 mm Hg气压维持下，将疝内容物回纳，再降低压力至2～4 mm Hg，以不可吸收线完成膈肌修补。结果除1例因脾脏出血中转开腹外，其余13例均顺利完成胸腔镜手术。手术时间90～150 min（平均116 min）。术中监测血气，13例完成胸腔镜手术患儿术中PaCO238～66 mm Hg （平均48 mm Hg），pH 7．18～7．39（平均7．30），乳酸0．55～1．22 mmol／L（平均0．93 mmol／L）。术后呼吸机通气时间49～192 h（平均113 h）。14例随访2～13个月（平均7个月），14例患儿均存活，无复发，1例术后5个月左侧肺炎，1例术后9个月因粘连性肠梗阻行手术治疗，余患儿均无呼吸困难、呼吸道感染症状或肠梗阻发生，生长发育良好。结论胸腔镜手术治疗新生儿CDH疗效满意。
목적：탐토흉강경수술치료신생인선천성격산（ congenital diaphragmatic hernia ，CDH）적료효。방법2013년9월～2014년8월응용흉강경치료신생인선천성격산14례，관찰공위우견갑하각제6륵간，치입5 mm trocar ，조작공2개，분별위우견갑하각선여척주련선중점제5～7륵간화액전선제5～7륵간，치입3 mm trocar；재6 mm Hg기압유지하，장산내용물회납，재강저압력지2～4 mm Hg，이불가흡수선완성격기수보。결과제1례인비장출혈중전개복외，기여13례균순리완성흉강경수술。수술시간90～150 min（평균116 min）。술중감측혈기，13례완성흉강경수술환인술중PaCO238～66 mm Hg （평균48 mm Hg），pH 7．18～7．39（평균7．30），유산0．55～1．22 mmol／L（평균0．93 mmol／L）。술후호흡궤통기시간49～192 h（평균113 h）。14례수방2～13개월（평균7개월），14례환인균존활，무복발，1례술후5개월좌측폐염，1례술후9개월인점련성장경조행수술치료，여환인균무호흡곤난、호흡도감염증상혹장경조발생，생장발육량호。결론흉강경수술치료신생인CDH료효만의。
Objective To analyze clinical outcomes of thoracoscopic repair of neonatal congenital diaphragmatic hernia ( CDH) . Methods Clinical data of 14 patients with CDH receiving thoracoscopic repair from September 2013 to August 2014 were retrospectively analyzed .Thoracoscopic observation port was placed at the site of subscapular angle on the sixth intercostal space for a 5 mm trocar .The two operational ports were located at the medium between scapular line and vertebral line on the level of fifth -seventh intercostal space and at the posterior axillary line on the level of fifth -seventh intercostal space , respectively, for 3 mm trocars.The CO2 pressure decreased to 2-4 mm Hg after reduction of herniated organ .The diaphragmatic defect was identified and repaired with prolene or polyester fiber interrupted sutures . Results Primary diaphragmatic repair was successfully accomplished under thoracoscope in 13 neonates without perioperative complications , while one patient underwent conversion to open surgery because of spleen bleeding.In the 13 thoracoscopic cases, the intraoperative PaCO2 was 38-66 mm Hg (average, 48 mm Hg), the pH value was 7.18-7.39 ( average, 7.30), the lactate level was 0.55 -1.22 mmol/L ( average, 0.93 mmol/L), and the postoperative mechanical ventilation time was 49-192 h(average, 113 h).All the cases were followed up for 2-13 months (average, 7 months). One patient required reoperation for adhesive intestinal obstruction at 9 months after operation and one case suffered pneumonia at 5 months after repair . There were no other long-term complications . Conclusion Strictly following surgical indications for thoracoscopic repair of CDH in neonates could achieve satisfactory efficacy .