本文選題：新生兒 + 先天性膈疝��； 參考：《北京協(xié)和醫(yī)學院》2014年博士論文

【摘要】：研究背景 先天性膈疝是新生兒外科危重癥之一。目前病因及發(fā)病機制尚未明確。外科手術是從根本上治療CDH的主要手段。目前先天性膈疝外科手術方式包括開放手術和腔鏡手術兩種。隨著微創(chuàng)外科的日益發(fā)展,越來越多的中心開始對新生兒膈疝行腔鏡下膈疝修補術治療。目前有研究認為腔鏡手術具有打擊小、術后恢復快、切口美觀等優(yōu)點,可作為新生兒先天性膈疝的治療途徑之一。但是,腔鏡手術與開放手術治療新生兒CDH的適應癥是否相同,腔鏡手術是否會有嚴重的并發(fā)癥,應如何防范和處理,經開放和腔鏡兩種途徑手術后患兒的臨床療效是否相當都值得進一步積累更多的患兒資料進行研究。 本次研究通過回顧性對比分析2002年-2014年我院收治的先天性膈疝患兒的臨床資料,通過比較開放手術與腔鏡手術行新生兒膈肌修補術的臨床效果,探討新生兒膈疝腔鏡手術的臨床療效、安全性和有效性,從而為進一步開展腔鏡下膈肌修補術治療新生兒CDH提供參考和依據。 目的 對比腔鏡手術和開放手術治療新生兒膈疝的臨床療效,探討腔鏡下治療新生兒膈疝的可行性及安全性,為進一步開展腔鏡下膈肌修補術治療新生兒先天性膈疝提供參考和依據。 方法 本研究回顧性分析我院2002年6月至2014年2月采取手術治療的59例新生兒膈疝患兒的病例資料。根據手術方式分為腔鏡手術組和開放手術組,其中腔鏡手術組19例,10例采用胸腔鏡,9例采用腹腔鏡；開放手術組40例。對比兩組患兒的年齡、體重、手術時間、手術出血量、及術后住院時間,術后并發(fā)癥及有無復發(fā)等資料,進行統(tǒng)計學分析比較。 為比較術者手術經驗對圍手術期觀察指標的影響,本研究按照腔鏡手術開展的時間順序分為近5年腔鏡組(n=11,2009年3月-2014年2月)和以往腔鏡組(11=8,2002年6月-2009年2月),比較兩組上述觀察指標的差異。 結果 1.兩組患兒的年齡[(3.4±0.2)d vs.(4.1±0.5)d,P=0.654]、體重[(3.3±0.3)kgvs.(3.5±0.2)kg, P=0.815]基本相同,無統(tǒng)計學差異。 2.腔鏡手術組的手術時間(115.6±31.2min),長于開放手術組的(92.5±19.4min)；腔鏡手術組術中出血量(1.53±0.22ml)、住院時間(14.2±2.7d)、術后通氣時間(1.8±0.2d)、術后抗生素使用時間(2.8±0.2d)均明顯少于開放手術組的(6.59±0.94ml)、(21.5±3.5d)、(5.1±0.9d)、(4.8±0.3d),差異有統(tǒng)計學意義(P0.05)。 3.腔鏡手術組和開放手術組兩組術后24h PCO2[(47.8±1.8mmHg)vs(48.6±1.5mmHg)]、術后胸腔積液發(fā)生率(10.5%vs7.5%)、復發(fā)率(15.8%vs5%)、存活率(94.7%vs95%)等觀察指標的比較,差異無統(tǒng)計學意義(P0.05)。 4.腔鏡手術組按手術開展的時間順序比較,近5年腔鏡組在手術時間(103.2±21.4min)、住院時間(13.8±2.1d)、復發(fā)率(9%)均少于以往腔鏡組的(121.8±35.3min)、(15.2±2.7d)、(25%),但差異無統(tǒng)計學意義。 結論 1.本研究結果表明腔鏡膈疝修補術安全、可行,具有術中出血少、創(chuàng)傷小、恢復快等優(yōu)點,臨床效果與開放手術相當,適用于新生兒先天性膈疝的手術治療。 2.隨著術者的經驗積累以及腔鏡技術的發(fā)展,腔鏡膈疝修補術的手術操作時間可以逐漸縮短,甚至接近開放膈肌修補術時間。 3.采用腹腔鏡或胸腔鏡膈肌修補術,應該根據術者自身經驗以及患者的實際情況進行合理的選擇,并且隨著腔鏡設備的更新?lián)Q代以及技術的進步,腔鏡下膈疝修補術的適應癥可以進一步擴大。
[Abstract]:Research background
Congenital diaphragmatic hernia is one of the critical diseases in newborn surgery. The etiology and pathogenesis are not yet clear. Surgical operation is the main means to cure CDH fundamentally. The current surgical methods of congenital diaphragmatic hernia include two kinds of open surgery and endoscopic surgery. With the development of minimally invasive surgery, more and more centers begin to hernia of the newborn The treatment of diaphragmatic hernia under the cavity mirror is considered as one of the ways to treat neonatal congenital diaphragmatic hernia. However, whether endoscopic surgery is the same with open surgery for neonatal CDH and whether endoscopic surgery will have serious complications and should have serious complications. How to prevent and deal with the clinical efficacy of the two ways after open and endoscopic surgery is worth further accumulation of more children's data to study.
By comparing the clinical data of congenital diaphragmatic hernia in our hospital in -2014 2002, the clinical effect, safety and effectiveness of diaphragmatic hernia surgery of neonatal diaphragmatic hernia were discussed by comparing the clinical effects of open surgery and endoscopic surgery for neonatal diaphragmatic repair, so as to further develop the diaphragm of the diaphragm. The repair is a reference and basis for the treatment of neonatal CDH.
objective
The clinical efficacy of endoscopic surgery and open surgery in the treatment of neonatal diaphragmatic hernia is discussed, and the feasibility and safety of endoscopic treatment of neonatal diaphragmatic hernia are discussed in order to provide reference and basis for further endoscopic diaphragmatic repair for neonatal congenital diaphragmatic hernia.
Method
This study retrospectively analyzed the data of 59 cases of neonatal diaphragmatic hernia in our hospital from June 2002 to February 2014. According to the surgical methods, the endoscopic surgery group and the open operation group were divided into endoscopic surgery group and open operation group, including 19 cases with endoscopic surgery, 10 cases with thoracoscopy, 9 cases of laparoscopy, 40 cases in open surgery group. The age and body of the two groups were compared. Weight, operative time, operative blood loss, postoperative hospital stay, postoperative complications and recurrence were compared and analyzed statistically.
In order to compare the effect of surgical experience on perioperative observation, the time sequence of endoscopic surgery was divided into 5 years' endoscopic group (n=112009 March -2014 February) and previous endoscopic group (11=82002 June -2009 February), and the differences of the above observation indexes were compared in the two groups.
Result
1. the age of the two groups was (3.4 + 0.2) d vs. (4.1 + 0.5) d, P=0.654], weight [(3.3 + 0.3) kgvs. (3.5 + 0.2) kg, P=0.815] was basically the same, there was no statistical difference.
The operation time of 2. endoscopic surgery group (115.6 + 31.2min) was longer than that in open operation group (92.5 + 19.4min), the amount of bleeding (1.53 + 0.22ml), hospitalization time (14.2 + 2.7d), postoperative ventilation time (1.8 + 0.2d), and postoperative antibiotic use time (2.8 + 0.2d) were significantly less than that of open operation group (6.59 + 0.94ml), (21.5 + 3.5D), (5.1 + 0.9). D), (4.8 + 0.3d), the difference was statistically significant (P0.05).
3. 24h PCO2[(47.8 + 1.8mmHg) vs (48.6 + 1.5mmHg) after operation group and open operation group. The incidence of pleural effusion (10.5%vs7.5%), recurrence rate (15.8%vs5%), survival rate (94.7%vs95%) and other observation indexes were not statistically significant (P0.05).
4. according to the time sequence of operation, endoscopic group was compared with the operation time (103.2 + 21.4min) and hospitalization time (13.8 + 2.1d), and the recurrence rate (9%) was less than that of the previous endoscopic group (121.8 35.3min), (15.2 + 2.7d), (15.2 + 2.7d), (25%), but the difference was not significant.
conclusion
1. the results of the study show that endoscopic diaphragmatic hernia repair is safe and feasible. It has the advantages of less bleeding, less trauma and rapid recovery. The clinical effect is equivalent to the open operation. It is suitable for the surgical treatment of congenital diaphragmatic hernia of the newborn.
2. with the accumulation of experience and the development of endoscopic technique, the operation time of the endoscopic diaphragmatic hernia repair can be gradually shortened and even close to the opening of the open phrenic muscle repair.
3. the use of laparoscopic or thoracoscopic diaphragmatic repair should make a reasonable choice according to the experience of the operator and the actual situation of the patient. With the renewal of the endoscope and the progress of the technique, the indication of the endoscopic diaphragmatic hernia repair can be further expanded.

【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：博士
【學位授予年份】：2014
【分類號】：R726.5

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相關期刊論文 前1條

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本文編號：1895356