目的 探讨胸腔镜手术治疗新生儿膈疝的手术经验及技术难点分析.方法 对27例新生儿CDH患儿采用胸腔镜手术治疗.顺序还纳疝入脏器,脾脏还纳时切忌使用尖锐器械直接压迫还纳,应间接推挤或以胃结肠等空腔脏器辅助推挤还纳,避免脾脏及血管撕裂导致出血.后外侧膈肌缺损严重者可行膈肌缘-肋间肌-膈肌缘缝合,适度打紧线结完成膈肌闭合修复.膈肌缺损严重可先连续缝合尽可能对合关闭缺损,测量缺损薄弱处大小,将体外裁剪好的补片置入胸腔,贴紧固定补片至膈肌薄弱处并以4-0 prolene线间断缝合.结果 27例膈疝中左侧25例,右侧2例.产前诊断23例,产前诊断胎龄为(28.2±5.1)周;出生孕周为(37.5±2.7)周,孕周最小为28.0周;出生体重为(2.90±0.70)kg,最小为1.36 kg.所有患儿均采用胸腔镜手术,23例顺利完成,4例中转.存活23例(85％),死亡4例(15％).手术年龄为出生后(41.0±40.0)h,手术时间为(159.0±14.0)min,行补片修补3例,术后有创呼吸机使用时间为(5.1±1.2)d,术后住院时间为(18.0±4.0)d.术后1例复发,第二次经胸腔镜完成手术,预后良好,3例并发胸腔积液均经保守治疗痊愈.结论 胸腔镜手术治疗新生儿CDH安全可行,术者有丰富的胸腔镜操作经验下,可优先考虑,补片修补可以在腔镜下顺利完成,术中心肺功能不稳定,二氧化碳分压(PaCO2)持续高于65～75 mmHg(1 mmHg=0.133kPa)应及时中转开放手术.低体重早产儿对胸腔镜手术的耐受性并不低于足月儿.“,”Objective To perform a retrospective analysis of neonates with congenital diaphragmatic hemia (CDH) and to summarize the dilemmas of thoracoscopic repairing.Methods From April 2014 to April 2019,a total of 27 CDH neonates underwent thoracoscopy.Due to an excellent visual field of pulmonary dysplasia,hernia viscera was sequentially returned into abdomen.Sharp instruments should not be directly compressed for restoring spleen along with stomach and colon.For severe defect of posterolateral diaphragm,suturing diaphragm margin-intercostal muscle-diaphragm margin and moderatdy tightening wire knot are employed for repairing diaphragm muscle and preventing recurrence.For severe diaphragmatic defect,continuous suture should be performed for closing defect as much as possible.And the size of weak defect was measured.Customized mesh was placed into chest cavity and fixed mesh tightly attached to weak diaphragm by interrupted suturing with 4-0 proline thread.Results The involved side was left (n=25) and right (n =2).Twenty-three cases were diagnosed prenatally.The average gestational age of prenatal diagnosis was (28.2±5.1) weeks,the average gestational age (37.5 ± 2.7) weeks and the average birth weight (2.90 ± 0.70) kg.Thoracoscopic repairs were successful (n =23) and converting into open operation (n=4).Among 23 survivors,the average operative age was (41 ± 40) hours and the average operative duration (159 ± 14) min.The average durations of ventilator supports and hospitalization were (5.1 ± 1.2) and (18.0± 4.0) days respectively.Three cases complicated with chylothorax were cured after conservative measures.There was one case of recurrence.However,based upon illness severity and operative duration,the prognoses of different groups showed no significant statistical differences.Conclusions Thoracoscopic repair is both safe and feasible for severe congenital diaphragmatic hernia in neonates.If a surgeon has extensive experiences,thoracoscopy may be selected as a first choice and completed successfully with patching.When cardiopulmonary functions are unstable and PaCO2 is continuously higher than (65-75) mmHg,thoracoscopy should be converted timely into open surgery.The thoracoscopic tolerance of low-weight premature infants is no less than that of full-term infants.