(精编)【体外膜肺ECMO精品课件】 Congenital diaphragmatic hernia教学课件.pptVIP

Congenital diaphragmatic hernia Pediatric Surgery Department History 1679 – Riverius recorded the first CDH 1761 – Morgagni desribed tycpes of CDH 1905 – Heidenhain repair CDH 1925 – Hedbolm suggested that CDH led to pulmonary hypoplasia and early operation improve survival 1946 – Gross correct CDH 24 hours of age 1980-1990 – delayed correction become wide Incidence 1 : 2000-5000 live birth 8 % of all major congenital anomalies mortality rate nearing 70 percent CDH accounts 1% of total infant mortality in USA Cost per new case CDH = 250 000 $ Diaphragm Development Prenatal Diagnosis ultrasonography diagnosis (as early as the second trimester) Mediastinal shunt ?? Viscera herniation (stomach, intestines, liver*, kidneys, spleen and gall bladder)????????????? ?? Abnormal position of certain viscera inside the abdomen ?? Stomach visualization out of its usual position ?? Intrauterine growth retardation* ?? Polyhydramnios* ?? Fetal hydrops* * bad prognosis Fetal diafragmatic hernia: Ultrasound diagnosis Prenatal MR Imaging - single-shot turbo spin-echo (HASTE)- of congenital diaphragmatic hernia Prenatal MR Imaging of congenital diaphragmatic hernia Pulmonary hypoplasia Anatomopathology show of CDH Prenatal Counseling multidisciplinary team patients obstetrician perinatologist geneticist surgeon social worker Prenatal management Glucocorticoids Thyrotropin-releasing hormone Fetal surgical therapy (Antenatal surgical intervention, In utero tracheal occlusion ) Delivery Room Management affected infants should be delivered in a center that has experienced personnel and available therapies. the team in the delivery room consist of personnel experienced in the immediate resuscitation and stabilization of critically ill neonates affected patients in any respiratory distress require positive pressure ventilation in the delivery room. To prevent distension of the gastrointestinal tract and further compression of the pulmonary parenchyma, a double-lumen n