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目的介绍腹腔镜技术治疗小儿先心病术后膈膨升的手术方法并探讨其安全性和疗效。方法自2007年至2014年,我们收治20例先心病术后膈膨升患儿,其中左侧13例,右侧7例,平均年龄9.5个月。采用腹腔镜三孔法完成膈肌折叠术,必要时在左上腹放一3 mm Trocar辅助牵拉。探查膈肌后,用2-0不可吸收带针缝线自左腹壁穿入腹腔,尾线留在腹壁外,间断“手风琴”式膈肌折叠缝合。采用腹腔内绕线、腹腔外牵拉尾线辅助打结,效果不满意时缝合两层,使膈肌平直并下降至正常水平。结果 20例均在腹腔镜下完成手术,平均手术时间60 min,出血量5 mL。术后24~48 h进食。出院前复查立位胸片,患侧膈肌下降至正常水平,无术中术后并发症。术后平均随访14.5个月,1个月、3个月复查胸片膈肌位置无明显改变,呼吸道症状明显缓解,无复发病例。结论腹腔镜下膈肌折叠术治疗小儿先心病术后膈膨升操作方便,安全性好,疗效确切。
Objective To introduce the method of laparoscopy in the treatment of diaphragmatic swelling after congenital heart disease (CHD) in children and to explore its safety and efficacy. Methods From 2007 to 2014, we treated 20 children with diaphragmatic swelling after congenital heart disease, including 13 cases on the left and 7 cases on the right, with a mean age of 9.5 months. Laparoscopic three-hole method to complete the diaphragmatic fold surgery, if necessary, place a 3 mm Trocar auxiliary pull in the left upper quadrant. Exploring the diaphragm, with 2-0 non-absorbable suture needle into the abdominal cavity from the left abdominal wall, leaving the tail in the abdominal wall, intermittent “Accordion ” type of diaphragm folding suture. Using intraperitoneal winding, extra-abdominal traction tail threading knot, the effect is not satisfied with two layers of suture, so that the diaphragm straight and down to normal levels. Results All the 20 cases underwent laparoscopic surgery with an average operation time of 60 min and a bleeding volume of 5 mL. After 24-48 h eating. Discharge chest X-ray examination before discharge, ipsilateral diaphragm decreased to normal levels, no intraoperative and postoperative complications. After an average follow-up of 14.5 months, 1 month and 3 months, there was no significant change in the position of diaphragmatic muscle of the chest radiograph. The respiratory symptoms were relieved without recurrence. Conclusion Laparoscopic diaphragmatic folds for the treatment of infantile congenital heart disease after diaphragmatic swelling is convenient, safe, and effective.