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先天性膈疝修补术(儿科)

ID: ANH13090chis
医疗动画文字记录:先天性膈疝是一种出生缺陷,婴儿膈肌的异常开口使腹部器官进入胸部。横膈膜是一大块圆顶状的肌肉,它将胸部和腹部分隔开。当小儿吸气时,膈肌和外侧肋间肌收缩,扩大胸腔。这种扩张降低了胸腔内的气压,造成压力变化,导致空气涌入肺部。当小儿呼气时,膈肌舒张,内侧肋间肌收缩,胸腔缩小。这种体积缩小增加了胸腔内的气压,迫使空气排出肺部。由于未知的原因,一些婴儿的横膈膜在出生前没有发育完全,导致胸部和腹部之间有一个开口。这个开口最常见的位置是在横膈膜的左侧,靠近背部。婴儿的腹部器官会通过横膈膜的这个开口突出,压迫肺部。因此,肺部不能完全发育,导致婴儿出生后呼吸困难。在手术前,婴儿会被全身麻醉,让他/她在整个手术过程中处于睡眠状态。经口腔或鼻腔气管插管,在手术中继续帮助婴儿呼吸。通常,医生会在左侧肋骨下开一个切口。接下来,医生会小心翼翼地将腹部器官从胸部移回它们在腹部的正常位置。如果膈膜上的孔很小,就只用缝合线缝合。如果孔太大,或者没有足够的肌肉来缝合,就会在上面缝一块补片。最后,用可溶解缝合线或封闭胶带敷料缝合切口。手术后,婴儿将被送往新生儿重症监护病房进行监护。采用机械呼吸机辅助婴儿呼吸几天或几周。医生会给予婴儿止痛药。婴儿可能会通过静脉注射继续接受抗生素治疗。住院时间可能会持续数周或数月,这取决于婴儿肺部的大小和状况。如果使用了补片,婴儿的生长将需要密切监测,因为补片不生长,可能开始脱离洞。

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