未经授权:先天性膈疝(CDH)是一种罕见的出生缺陷。当生命1个月后发现症状时,称为迟发性CDH。迟发性CDH的临床表现多样,其中最致命的是紧张性胃胸引起的心脏骤停。这种疾病很罕见,由于紧急治疗不当,很容易导致死亡。本报告说明了三名中国儿童的晚期CDH伴紧张性胃胸的紧急治疗。
未经授权:三名儿童因突然呼吸困难被送往急诊室,通过X射线或计算机断层扫描准确诊断。在情况1中,第一次尝试时无法插入胃管,孩子不停地哭。当重新插入胃管时发生心脏骤停。心肺复苏和放置胸腔引流管后,大量气体和胃内容物被排出。进行腹腔镜手术。患者死于败血症。在情况2中,第一次尝试时无法插入胃管;因此,紧急手术被考虑而不是重试。病人麻醉后,成功放置了胃管。随后,大量的气体和胃内容物被排出,并进行了胸腔镜手术。病人恢复均匀。在案例3中,第一次尝试成功插入胃管;然而,由于胃管引流不良,生命体征不稳定。我们将20ml碘海醇注入胃管进行血管造影和动态胸片监测。调整好胃管位置后,胃完全塌陷。进行胸腔镜手术。病人恢复均匀。
UASSIGNED:早期诊断对于晚期表现的CDH并发紧张性胃胸的儿童至关重要。胃完全塌陷是紧急治疗的关键步骤。此外,胃管插入是首选。在第一次尝试胃管放置困难的儿童中,胃管可以放在麻醉下,同时进行紧急手术。在胃完全塌陷的情况下,内镜手术可以是首选。
UNASSIGNED: Congenital diaphragmatic hernia (CDH) is a scarce birth defect. It is called late-presenting CDH when symptoms are found after 1 month of life. The clinical manifestations of late-presenting CDH are diverse, among which the most fatal is the cardiac arrest caused by tension gastrothorax. The disease is rare, can easily lead to death owing to improper emergency treatment. This report illustrates the emergency treatment of late-presenting CDH with tension gastrothorax in three Chinese children.
UNASSIGNED: Three children presented to emergency room with a sudden dyspnea, diagnosed accurately by x-ray or computed tomography. In
case 1, the gastric tube could not be inserted at the first attempt, and the child cried incessantly. Cardiac arrest occurred when the gastric tube was re-inserted. After cardiopulmonary resuscitation and placement of a thoracic drainage tube, a large amount of gas and stomach contents were drained. Laparoscopic surgery was performed. The patient died of sepsis. In
case 2, the gastric tube could not be inserted at the first attempt; consequently, emergency surgery was considered instead of retrying. After the patient was anesthetized, a gastric tube was successfully placed. Subsequently, a large amount of gas and gastric contents was drained, and thoracoscopic surgery was performed. The patient recovered evenly. In
case 3, the gastric tube was successfully inserted at the first attempt; however, the vital signs were unstable due to poor drainage of the gastric tube. We injected 20 ml of iohexol into the stomach tube for angiography and dynamic chest film monitoring. After adjusting the position of the stomach tube, the stomach collapsed completely. Thoracoscopic surgery was performed. The patient recovered evenly.
UNASSIGNED: Early diagnosis is essential for children with late-presenting CDH complicated by tension gastrothorax. Fully collapsing the stomach is a key step in emergency treatment. In addition, gastric tube insertion is the first choice. In children with difficulty in gastric tube placement at the first attempt, the gastric tube can be placed under anesthesia, and emergency surgery performed simultaneously. Endoscopic surgery can be the first choice in cases of complete stomach collapse.