目的

探讨胸腔镜新生儿先天性膈疝（CDH）修补术的治疗疗效。

方法

选择2016年5月至2023年4月于昆明市儿童医院心胸外科采取胸腔镜手术治疗的19例CDH 新生儿为研究对象。对其临床资料，如性别、出生体重及出生胎龄、CDH 所在位置、手术治疗情况及治疗疗效进行回顾性分析。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

结果

这19例CDH 患儿的临床资料及治疗疗效分析如下。①临床资料：男性患儿为7例（36.8%），女性为12例（63.2%），CDH 位于左、右侧膈肌各为14例（73.7%）、5例（26.3%）；均为足月产儿，出生体重为（3.2±0.3）kg。②治疗策略：对其均采取胸腔镜手术治疗，手术日龄为4 d（2 d，7 d），手术时间为（129.0±40.6）min，术中出血量中位数为3 m L（1 m L，10 m L）；术后胸腔引流管放置中位时间为7 d（2 d，48 d）。③治疗疗效：胸腔镜手术中转开胸手术患儿为1例；顺利出院为18例，胸腔镜手术治疗成功率为94.7%；1例于术后第2天出现呼吸循环衰竭，放弃治疗；预后良好患儿为16例（84.2%），失访为3例；CDH 术后复发为2例。

结论

采取胸腔镜下CDH 修补术治疗新生儿CDH，具有术中出血量少、存活率高、预后良好等特点，治疗有效、可行。

Objective

To explore the therapeutic efficacy of thoracoscopic surgery for congenital diaphragmatic hernia（CDH）in newborns.

Methods

A total of 19 newborns with CDH who underwent thoracoscopic surgery at the Department of Cardiothoracic Surgery，Kunming Children's Hospital from May 2016 to April 2023 were selected as study subjects.A retrospective analysis was conducted on the clinical data of their gender，birth weight，gestational age，side of CDH，surgical treatment and surgical efficacy.The study protocol was performed in accordance with the Helsinki Declaration of the WorldMedical Association revised in 2013.

Results

The clinical data and treatment efficacy of these 19 children with CDH were analyzed as follows.①Clinical data：7 cases（36.8%）were male and 12 cases were female （63.2%）.14 cases （73.7%）were left CDH and 5 cases （26.3%）were right CDH.All 19 children were born at full term，the birth weight was（3.2±0.3）kg.②Treatment strategies：Thoracoscopic surgery was performed in all 19 patients，with a median age of 4 d（2 d，7 d）.The surgical time was （129.0±40.6）min，and the median intraoperative bleeding volume was 3 m L（1 m L，10 m L）.The median postoperative drainage tube placement time was 7 d（2 d，48 d）.③Treatment efficacy：One patient required conversion to open chest surgery during the thoracoscopic procedure.18 patients were discharged without complications，the success rate of thoracoscopic surgery in this group of pediatric patients was 94.7%.One patient developed respiratory and circulatory failure on the second day after surgery and gave up treatment；16 patients （84.2%）had a good prognosis，and 3 patients were lost to follow-up；two patients had recurrence of CDH.

Conclusions

The benefits of thoracoscopic surgery for CDH in newborns are considerable，with a low amount of blood loss，a high survival rate，and a good prognosis.