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目的 先天性膈疝(congenital diaphragmatic hernia,CDH)是新生儿严重畸形之一,且往往合伴其他畸形,病死率高.本文通过回顾性资料分析了解左侧CDH与右侧CDH临床和治疗方案的比较.方法 收集上海交通大学医学院附属新华医院2006年11月至2016年11月收治的131例CDH患儿,男73例,女58例,其中左侧111例,右侧20例,左侧CDH显多于右侧(占总数85％).比较其出生体重、年龄、产前诊断、孕周、胎龄、入院血气PH指标、合伴畸形、肺动脉高压、呼吸机应用、术中治疗方案(含开腹手术、腹腔镜微创手术和胸腔镜手术)、术中补片使用、预后转归分析.资料采用SPSS 19.0软件统计分析.计量资料正态分布用于±s表示,组间比较用独立样本f检验;偏态分布用中位数和四分位数间距(M,Q)表示,组间比较采用独立样本秩和检验;计数资料采用x2检验.随访0.5～8年(平均3.4年).结果 术后死亡21例,病死率16％,死亡原因主要是肺发育不全、肺动脉高压,本组中占56例(43％),且有心脏及其他脏器畸形者95例(73％),对大缺损的CDH,采用补片辅助修补,使用率19/131(15％).左、右侧CDH分别作了比较.其中左侧CDH 111例,男67例,女44例,出生体重(3 222.26±460.59)g,产前诊断73/111 (65.8％),合伴其他畸形80/111(72.1％),复发7/111 (6.3％),补片16/111 (14.4％),术后死亡18/111 (16.2％);而右侧CDH男6例,女14例,出生体重(2 737.00±447.40)g,产前诊断16/20(80％),合伴畸形15/20(75％),复发1/20(5％),补片3/20(15％),术后病死率3/20(15％).除了性别和出生体重有显著差别外(P＜0.05),其他项目差异无统计学意义.本组手术方法采用腹部开放手术、胸腔镜和腹腔镜三种手术方法,随访了20例CDH术后情况,因地址更改等因素,随访率仅20/110(18％),随访时间平均3.4年,也作为参考及下一步继续追踪中.CDH主要并发症为上呼吸道反复感染、营养不良、智力发育差.结论 左右侧先天性膈疝术后病死率无差异,肺发育不全和肺动脉高压是CDH死亡的重要原因之一.微创手术病死率低于开放手术.因本组随访率低,有待进一步追踪中.“,”Objective As a severe neonatal malformation with a high mortality,congenital diaphragmatic hernia (CDH) is commonly complicated with other malformations.This article compares clinical and treatment regimens of left and right sides of CDH by retrospective data analysis.Methods From November 2006 to November 2016,a total of 131 CDH cases were hospitalized and treated at our hospital.Clinical parameters were compared and analyzed with SPSS 19.0 software.A normal distribution of measurement data was expressed as mean ± standard deviation (x ± s),independent sample t-test for assessing inter-group difference;skewed distribution expressed by median and quartile spacing (M,Q) and independent sample rank sum test for assessing inter-group difference;count data assessed by x2 test.The average follow-up period was 3.4 (0.5-8) years.Results In total,21 CDH patients died postoperatively with a mortality rate of 16％.The major mortality causes were pulmonary hypoplasia and pulmonary arterial hypertension accounting for 56 cases (43％) in the group.And 95 cases (73％) were complicated with heart or other organ malformations.Both left and right sides were compared respectively.Among 111 cases with left CDH,there were 67 boys and 44 girls with an average birth weight of 3222.26 ± 460.59 grams,73 (65.8％) were prenatally diagnosed,80 cases (72.1％) complicated with other malformations,7 patients (6.3 ％) relapsed,16 (14.4 ％) repaired with patches and 18 patients (16.2％) died postoperatively.Among 20 right CDH patients,there were 6 boys and 14 girls with an average birth weight of 2 737.00 ± 447.40 grams,16 (80％) were prenatally diagnosed,15 (75％) cases complicated with other malformations,1 patient (5％) relapsed,3 (15 ％) repaired with patches and 5 (15 ％) died postoperatively.Regarding the selection of surgical approaches,our data suggested that mini-invasive operation fared better.For 20 cases of CDH,the postoperative follow-up rate was 20/110 (18％) and the average follow-up period 3.4 years.The major complications of CDH included recurrent infections of upper respiratory tract,malnutrition and poor intelligence development.Conclusions The mortalities of patients with left and right CDH have no difference.Major mortality causes of death are pulmonary hypoplasia and pulmonary arterial hypertension.A low follow-up rate should be rectified by further in-depth studies.