~Teachingcenter的醫學筆記~

鰓裂囊腫(branchial cleft cyst)(= branchial sinus)
鰓裂瘻管(branchial cleft fistula)
=可以參考：
----小兒外科題目-鰓裂瘻管
http://teachingcenter1.pixnet.net/blog/post/283023580
----一些頸部疾病整理
http://teachingcenter1.pixnet.net/blog/post/350573132
----Pharyngeal arch 咽弧(咽弓)的發育
http://teachingcenter1.pixnet.net/blog/post/344129249
----咽器Pharyngeal Apparatus
http://teachingcenter1.pixnet.net/blog/post/353714186

=幼兒先天性鰓裂瘻管最常發生於第二對腮裂，出口多在胸鎖乳突肌下1/3~2/3內側

圖片來源：http://www.surgicalcore.org/

先天橫膈膜疝氣(congenital diaphragmatic hernia)

=Triad of congenital diaphragmatic hernia (可見於Bochdalek hernia或Morgagni's henia)
----Respiratory distress
----Apparent dextrocardia
----Scaphoid abdomen
=一般左後外側最常見，因為此部分胚胎發育較晚，又稱Bochdalek hernia
=第二常見為胸骨下的區域，又稱Morgagni hernia
=缺陷那一側的肺臟發育會較差
=術前處置(preoperative treatment of congenital diaphragmatic hernia)
--放置口胃管減壓(oral-gastral (OG) tube decompression)
--給予適當鎮靜的狀況下插管並使用呼吸器(mechanical ventilation with sedation)
***PaO2 80~100 torr
***PCO2 < 35 torr
***pH > 7.4 (postductal ABG)
--建立靜脈輸液
--兩條A-line分別建立於右橈動脈和臍動脈(pre-/post- ductal arterial cannula – right radial artery and umbilical artery catheter)
--術前處置的重要性不比手術本身低，在確立以上處置後，一般約是出生後48小時左右手術(delayed surgery 48 hours)
圖片來源：http://www.continentalhospitals.com/blog/diaphragmatic-hernia/

A = Congenital absence of diaphragm (unilateral agenesis of diaphragm)
B = Inferior vena caval foramen
C = Foramen of Morgagni (parasternal)
D = Esophageal hiatus
E = Foramen of Bochdalek (pleuropheritoneal hiatus, posterolateral)
F = Left crus of diaphragm
G = Aortic hiatus
H = Left bundle of the right crus
I = Right bundle of the right crus

先天橫膈膜疝氣(congenital diaphragmatic hernia)的嬰兒，其出生須急救的步驟不包括下列何者？
(A)氣管內插管(endotracheal tube)
(B)面罩(mask)給氧氣
(C)放置口胃管
(D)動脈及靜脈導管
Ans: B.
面罩給氧會使胃的空氣量增加，更加擠壓肺臟，使得病況加重！