Abstract
Purpose : The aim of our study was to investigate the significance of preoperative stabilization of patients with congenital diaphragmatic hernia (CDH), the timing of surgery, and the effectiveness of our protocol. Methods : A retrospective analysis of an emergency surgical repair group (n=23) and a delayed surgical repair group (n=29) was performed. All 52 cases of CDH were diagnosed within the first 24 hours of life and began to be treated soon after birth. Results : Survival rates for the two groups were 82.6% (emergency group) and 72.3% (delayed group) respectively, and this difference was not statistically significant. Patients whose best AaDO_2 could be maintained at ≦250 torr by the time of surgery all survived. There was a negative correlation between best AaDO_2 and LW/BW ratio. Conclusions : The average survival rate for surgery performed according to our protocol was 90.9%. [1. Our protocol involves improving persistent pulmonary hypertension of the newborn (PPHN), 2. Elimination of flip flop. 3. Stabilization of cardiac function. 4. Maintenance of AaDO_2≦250 torr.] Patients who underwent surgical repair according to our protocol were easy to manage. The improved survival rate of the delayed surgical repair group was probably due to planned delivery to best facilitate treatment. We believe that untreatable cases with severe pulmonary hypoplasia can be selected out by persisting with our protocol for stabilization for at least 24 hours. If the patient can not be stabilized, successful outcome is unlikely.
