腔镜手术治疗新生儿及婴幼儿膈肌发育缺陷

目的探讨腔镜手术治疗新生儿及婴幼JLN肌发育缺陷的可行性和优越性。方法38例膈肌发育缺陷患儿，其中膈疝4例，膈膨升5例，食管裂孔疝29例。术前均经上消化道造影及胸腹CT检查确诊；腹腔镜下探查膈肌病变类型及有无合并病变；膈疝患儿行膈肌修补缝合术，食管裂孔疝行食管裂孔修补Nissen胃底折叠术，膈膨升患儿行膈肌折叠术。结果38例中3例中转开放手术，其余35例采用腹腔镜技术完成手术。平均手术时间147min（75—210min）；手术中出血量平均5mL（1—10mL）。患儿术后平均24h饮水，5d恢复饮食；术后平均住院时间6．7d。随访1个月至5年，原有症状消失，体重增加，生长发育正常，无明显并发症发生。2例食管裂孔疝术后3个月及1年复发，经再次腔镜手术后治愈。2例食管裂孔旁疝分别复发2次，1例现第3次腔镜手术后1年余无复发；另1例术后4个月食管裂孔疝复发、胃小弯侧靠近幽门处穿孔，行膈肌修补、胃穿孔修补；第二次手术后3个月再次复发，行生物补片修补，随访至今4个月无异常。结论腔镜手术治疗新生儿及婴幼儿膈肌发育缺陷疗效确切，安全可行。

Study of laparoscopic operation in treatment of neonatal and infant diaphragmatic defects.

Objetive To investigate the efficacy and superiority of the laparoscopic operation of develop- mental defect of diaphragm in infants. Methods 38 patients with developmental defect of diaphragm, 4 dia- phragmatic hernia ,29 hiatus hernia and 5 Diaphragmatic Eventration, underwent laparoscopic repairs of dia- phragmatic hernia or hiatus hernia, or plication of diaphragm. Results The procedure was completed laparo- scopically in 35 cases and 3 cases were turned to open procedure. The median operating time was 1＂47 min （ range 75 to 210）. No complication occurred; 38 patients were asymptomatic at last follow-up （ range 1 month to 5 years）. 4 patients relapsed after surgery; 2 of them were re -operated by laparoseopic repair and no relapse has been observed; while the other two patients, relapsed again after a second operation, 1 case underwent the third laparoscopic repair,and no recurrence was observed in the following year. Conclusions The laparoscopic access to the operation of newborn and infant developmental defect of diaphragm was efficacy and safety.