食管閉鎖膈疝經胸腔鏡手術治療食管閉鎖膈疝病例報告

江西省兒童醫(yī)院新生兒外科

經胸腔鏡手術治療

食管閉鎖、膈疝病例報告2010年1月至2011年5月

食管閉鎖13例+1

膈疝9例+1+1

EA±TOFN=13（typeC11,A2）Numberofports:3portsDurationoftheoperation135~220minutesPostoperativehospitalstay:15-30daysConversion：1EA±TOFEA±TOF術后處理術后7天術后15天隨訪：術后4月EA±TOF9例基本情況表病例性別手術日齡(d)體重(kg)閉鎖類型合并畸形兩端距離(cm)手術時間(min)呼吸機支持時間(h)吻合口漏食道狹窄療效住院天數(shù)(d)1男62.4ⅢB118036無是治愈182男102.1ⅠF44.5205168漏--放棄113女41.8ⅢB雙胎早產2.015026無無治愈294男52.1ⅢA右足畸形2.616048漏是治愈335女52.7ⅢB0.51358無無治愈256男112.7ⅢAVSD3.01600無是治愈177男71.4ⅢA3.2中轉72----死亡108男53.1ⅢBVSD,PH1.613519無無治愈209男23.1ⅢB1.01450無無治愈18先天性膈疝

congenitaldiaphragmatichernia(CDH)N=9（L8,R1）Numberofports:3~4portsDurationoftheoperation56~160minutesPostoperativehospitalstay:15-33daysConversion：0先天性膈疝手術方法1、氣管插管+全麻2、側臥位3、3~4孔，CO2氣壓4-13mmHg4、直接縫合/折疊先天性膈疝9例膈疝基本情況表病例性別手術日齡(d)類型疝囊手術方法手術時間(min)并發(fā)癥療效住院天數(shù)(d)1男3m左膈疝有3孔折疊121皮下積氣治愈202男1d左膈疝無3孔縫合106左胸腔積液肺發(fā)育不良治愈293男1d左膈疝有3孔折疊102治愈154女7d左膈疝有3孔縫合102治愈335男1d左膈疝有3孔縫合56治愈256男4m22d右膈膨升-4孔折疊160治愈177男3d左膈疝有3孔縫合92治愈198男7d左膈疝有3孔縫合111治愈209男2m左膈膨升-4孔折疊119治愈18先天性膈疝術后6月術后3天術前討論食道閉鎖膈疝

Holcomb2005李龍、等2007.3吳曄明、等2009.5

黃金獅、等2011.病例數(shù)1043/64/69吻合口瘺7.60%022吻合口狹窄31.70%033.70%3胃底成形術

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NickLansdale,etal.NeonatalEndosurgicalCongenitalDiaphragmaticHerniaRepairASystematicReviewandMeta-Analysis(AnnalsofSurgery?