Surgical Treatment Of Congenital Diaphragmatic Defects In Children

Congenital Diaphragmatic Developmental Defects includes three kinds ofcongenital diaphragmatic disease, hiatal hernia, congenital diaphragmatic andeventration of diaphragm. This thesis consists of three parts:(1) Clinical studies ofchildren with congenital hiatal hernia by laparoscopic surgery;(2) Clinical analysisof minimally invasive surgical treatment of infants with eventration of diaphragm;(3)Prenatal diagnosis of congenital diaphragmatic hernia: prognostic factors analysis. Section I. Clinical studies of children with congenital hiatal herniaby laparoscopic surgeryObjective To investigate the intraoperative and postoperative complications,efficacy and outcome in two groups of laparoscopic surgery for esophageal hiatalhernia in children, in order to provide guidance for clinical treatment.Methods Retrospectively analyzed for total154children with esophageal hiatalhernia underwent laparoscopic Nissen or Thal fundoplication from February2003toDecember2013in Shanghai Xinhua Hospital and from October2000to December2013in Shanghai Children’s Medical Center. Evaluate and analyze the clinical dataof two types of laparoscopic fundoplications.Results Except4cases converted to open surgery, all the cases completedlaparoscopic fundoplications procedures among which78cases underwent a Nissenand72a Thal fundoplication. During the follow-up after operation，there were3patients (3.8%) with gastroesophageal reflux,19patients (24.4%) with esophagealmild stenosis but no symptoms in Nissen group. In the Thal group, there were13patients (18.1%) with gastroesophageal reflux，6patients (8.3%) with esophageal mild stenosis but no symptoms.Conclusions In the long-term outcomes, there were statistical differences for ahigher rate of gastroesophageal reflux in Thal group and a higher rate of esophagealstenosis in the Nissen group. Section II. Clinical analysis of minimally invasive surgical treatmentof infants with eventration of diaphragmObjective Here, we report our experience with different plication procedures todiscuss how to choose among these different plication procedures in endoscopicsurgery for pediatric patients with diaphragmatic eventration.Methods We retrospectively analyzed clinical data of27pediatric patients admittedto our hospital between November2008and July2013. Three different plicationprocedures were used: the “reefing the Mainsail” technique (8patients),“invaginating the diaphragmatic dome” technique (10patients), and “pleating”technique (9patients).Results Descending distance of diaphragm after surgery ranged from1to4.5intercostal spaces (mean distance:2.67intercostal spaces). All patients recoveredwell postoperatively, except for one patient with a pneumothorax. Clinical resultswere satisfactory with obvious improvement in symptoms and a slight re-elevationwithin a distance of one intercostal space.Conclusions For pediatric patients with diaphragmatic eventration, differentendoscopic surgeries and plication procedures all yielded satisfactory results. Webelieve that the choice of one procedure over the other depends only on the surgeon’s experience. Section III. Prenatal check and intervention timing of congenitaldiaphragmatic hernia: prognostic factors analysisObjective Prenatal diagnosis of congenital diaphragmatic hernia is significant for itstimely, accurate treatment and prognostic judgment. This study analyzed the clinicaldata of patients to present various factors affecting the cure rate in children.Methods We retrospectively analyzed clinical data of91pediatric patients admittedto our hospital between January2001and December2013. They are divided intogroups of prenatal diagnosis and no prenatal diagnosis. In A2group,multidisciplinary production process, sex, gestational age, associated malformations,and lung-to-head ratio (LHR) were recorded.Results87cases underwent surgical treatment and4cases discharged withouttreatment. Open surgery in64cases, minimally invasive surgery in23cases.74cases are cured (81.3%),13cases died (14.3%). LHR in death group was1.32±0.43,cure group was1.96±0.51, P <0.05.Conclusions Smaller the gestational age, higher the mortality in CDH, gestationalage>30weeks, the prognosis is good.