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目的总结先天性膈疝的围手术期处理经验,以提高先天性膈疝患儿的抢救成功率和生存质量。方法回顾性对比研究四川大学华西医院1998年1月至2005年4月23例新生儿先天性膈疝患儿的围手术期处理的资料,接受手术21例,其中重症患儿16例,延期手术11例,紧急手术5例;非重症患儿5例,延期手术4例,紧急手术1例。结果急诊手术6例中,存活3例,延期手术15例中,存活11例。重症组中延期手术组,病死率为36.4%,紧急手术组病死率为60%,而非重症组中紧急手术和延期手术病例均存活。产前经B超检出的12例,无论是紧急手术还是延期手术,均全部存活。术后并发切口感染2例、切口裂开1例、肺部感染3例、硬肿症2例,死亡(呼吸循环衰竭)7例。死亡病例均为重症,其中并发肺部感染者2例,并发硬肿症者1例,均为紧急手术者。结论对重症先天性膈疝患儿,积极改善肺功能,待呼吸循环状况稳定后延期手术治疗,可以提高患儿的存活率。
Objective To summarize the experience of perioperative treatment of congenital diaphragmatic hernia in order to improve the rescue success rate and quality of life of children with congenital diaphragmatic hernia. Methods The data of perioperative management of 23 neonates with congenital diaphragmatic hernia in West China Hospital of Sichuan University from January 1998 to April 2005 were analyzed retrospectively. Twenty-one patients underwent surgery, including 16 critically ill children and delayed operation Cases, emergency surgery in 5 cases; non-critical children in 5 cases, delayed surgery in 4 cases, emergency surgery in 1 case. Results In the 6 cases of emergency operation, 3 cases survived and 15 cases were delayed operation, and 11 cases survived. In the severe group, the delayed operation group had a case fatality rate of 36.4% and the emergency operation group had a case fatality rate of 60%. In the non-severe group, both the emergency operation and the delayed operation survived. Prenatal B ultrasound detected in 12 cases, whether emergency or deferred surgery, all survived. Incisional incision infection in 2 cases, incision split in 1 case, pulmonary infection in 3 cases, scleredema in 2 cases, death (respiratory failure) in 7 cases. Deaths were severe cases, including 2 cases of pulmonary infection complicated by sclerema in 1 case, are emergency surgery. Conclusion In children with severe congenital diaphragmatic hernia, positive pulmonary function can be improved. When the respiratory cycle condition is stable, deferred surgery can improve the survival rate in children.