Yue Fang,Wang Xianshu,Yang Zhiguo,et al.Comparison of thoracotomy versus thoracoscopy in the treatment of diaphragmatic eventration in children[J].Journal of Clinical Pediatric Surgery,2019,18(06):508-513.[doi:10.3969/j.issn.1671-6353.2019.06.014]
胸腔镜与开胸手术治疗婴幼儿先天性膈膨升的对比研究
- Title:
- Comparison of thoracotomy versus thoracoscopy in the treatment of diaphragmatic eventration in children
- Keywords:
- Thoracoscopes; Thoracic Surgical Procedures; Diaphragmatic Eventration/SU; Treatment Outcome; Infant; Child
- 分类号:
- R726.2;R565+.1
- 摘要:
- 目的 比较开胸与胸腔镜手术治疗婴幼儿先天性膈膨升的疗效，总结胸腔镜手术治疗婴幼儿先天性膈膨升的的经验。方法 回顾性分析2012年3月至2018年3月由河北省儿童医院收治的87例婴幼儿膈膨升患儿的临床资料，按手术方式分为开胸组与胸腔镜组，分析比较两组患儿年龄、性别、体重、发病侧别、膈肌抬高肋单元、手术时间、术后呼吸机支持时间、胸腔闭式引流天数、住院天数和术后并发症等情况。结果 两组患儿年龄、性别、体重、发病侧别、膈肌抬高肋单元等基本特征比较差异无统计学意义（P>0.05）。开胸组手术时间平均为（90.71±2.89）min，胸腔镜组为（78.81±3.48）min，胸腔镜组手术时间缩短（t=1.924，P=0.01）。开胸组术后呼吸机支持时间平均为（12.17±2.07）h，胸腔镜组为（5.71±0.89）h，胸腔镜组呼吸机支持时间短于开胸组（t=2.960，P=0.0036）；开胸组胸腔闭式引流时间平均为（3.07±0.12）d，胸腔镜组为（1.85±0.23）d，胸腔镜组胸腔闭式引流时间短于开胸组（t=11.500，P<0.001）；开胸组术后住院天数平均为（10.57±0.19）d，胸腔镜组为（8.08±0.14）d，胸腔镜组住院天数短于开胸组（t=10.530，P<0.001）。胸腔镜组瘢痕恢复程度优于开胸组，随访3个月至3年，均无复发。结论 与开胸手术相比，胸腔镜具有手术打击小、恢复快、住院时间短、瘢痕小等优势，手术疗效确切、安全有效。
- Abstract:
- Objective To compare the efficacy of thoracotomy versus thoracoscopy and summarize the experiences of thoracoscopy in the treatment of congenital diaphragmatic eventration (CDE) in infants. Methods From March 2012 to March 2018,retrospective analysis were performed for the clinical data of 87 CDE cases.According to operative approaches,they were divided into thoracotomy and thoracoscope groups.Two groups were compared in terms of age,gender,weight,affected sideness,degree of diaphragmatic elevation,operative duration,postoperative ventilator support length,chest closed drainage duration,hospitalization stay and postoperative complications.Results No statistically significant inter-group difference existed in age,gender,weight,affected sideness or degree of diaphragmatic elevation (P>0.05).The operative duration of thoracoscopy group was longer than that of thoracotomy group[(90.71±2.89) vs.(78.81±3.48) min](t=1.924,P=0.01); postoperative ventilator support time shorter[(5.71±0.89 vs.12.17±2.07 hours)](t=2.960,P=0.0036); closed thoracic drainage duration shorter[(1.85±0.23) vs.(3.07±0.12) days] (t=11.500,P<0.001); hospital stay shorter[(8.08±0.14) vs.(10.57±0.19) days](t=10.530,P<0.001).There were three wounds (each about 0.7 cm long) and the scars were smaller in thoracoscopy group than those in thoracotomy group.Both groups were followed up for 3 months to 3 years without recurrence. Conclusion As compared with thoracotomy,thoracoscopy offers the advantages of small operative shock,a quicker recovery,a shorter hospitalization stay and minimal scar.
参考文献/References:
1 江泽熙,胡廷泽.小儿胸部外科学[M].湖北科学技术出版社,2008:256-258. Jang ZX,Hu YZ.Pediatric Thoracic Surgery[M].Hubei:Hubei Science and Technology Publishing House,2008:256-258.
2 Burnside ES,Ochsner JE,Fowler KJ,et al.Use of microcalcification descriphtors in BI-RADS 4th edition to stratify risk of malignancy[J].Radiology,2007,242(2):388-395.DOI:10.1148/radiol.2422052130.
3 Kettritz U.Minimally Invasive Biopsy Methods-Diagnostics or Therapy? Personal Opinion and Review of the Literature[J].Breast Care (Basel),2011,6(2):94-97.DOI:10.1159/000327889.
4 Huang PC,Cheung YC,Lo YF,et al.A comparison of spring-loaded and vacuum-assisted techniques for stereotactic breast biopsy of impalpable microcalcification Iesions:experience at Chang Gung Memorial Hospital at Linkou[J].Chang Gung Med J,2011,34(1):75-83.
5 Kokorowski PJ,Wang HH,Routh Jc,et al.Evaluation of the contralateral inguinal ring in clinically unilateral inguinal hernia:a systematic review and meta-analysis[J].Hernia,2014,18(3):311-324.DOI:10.1007/s10029-013-1146-z.
6 Kalantari M,Shirgir S,Ahmadi J,et al.Inguinal hermia and ocdurrence on the other side:a prospective analysis in Iran[J].Hernia,2009,13(1):41-43.DOI:10.1007/s10029-008-0411-z.
7 Matsubara H,Miyauchy Y,Ichihara T,et al.Thoracoscopic diaphragmatic plication for eventration of diaphragm in children using no-knife automatic suturing device[J].Kyobu Geka,2014,67(11):976-979.
8 赵成鹏,段永福,周晓波,等.胸腔镜与开放手术治疗小儿先天性膈膨升的比较[J].中国微创外科杂志,2015,15(6)502-504.DOI:10.3969/j.issn.1009-6604.2015.06.006. Zhao CP,Duan YF,Zhou XB,et al.Comparative study between thoracoscopic and open surgery for congenital diaphragmatic eventration in children[J].Chin J Min Inv Surg,2015,15(6)502-504.DOI:10.3969/j.issn.1009-6604.2015.06.006.
9 刘江斌,闰宪刚,陈功,等.开放手术与胸腔镜治疗小儿先天性膈膨升的疗效对比观察[J].中华小儿外科杂志,2014,35(1):39-42.DOI:10.3760/cma.j.issn.0253-3006.2014.01.010. Liu JB,Run XG,Chen G,et al.Comparative study of open and thoracoscopic repair for congenital diaphragmatic eventration in children[J].Chin J Pediatr Surg,2014,35(1):39-42.DOI:10.3760/cma.j.issn.0253-3006.2014.01.010.
10 Yazici M,Karaca I,Afikan A,et al.Congenital eventration of the diaphragm in chaildren:25 year’s experience in three pediatric surgery centers[J].Eur J Pediatr Surg,2003,13(5):298-301.DOI:10.1055/s-2003-43573.
11 Hines MH.Video-assisted diaphragm placation in children[J].Ann Thorac Surg,2003,76(1):234-236.
12 王勇,汤绍涛,毛永忠,等.腔镜下治疗小儿膈肌疾病31例[J].临床小儿外科杂志,2010,9(6):441-442.DOI:10.3969/j.issn.1671-6353.2010.06.013. Wang Y,Tang ST,Mao YZ,er al.Laparoscoplic treatment of 31 cases of pediatric diaphragmatic disease[J].J Clin Ped Sur,2010,9(6):441-442.DOI:10.3969/j.issn.1671-6353.2010.06.013.
13 Liu DC,Flattmenn CJ,Karam MT,et al.Laparoscopic fundoplacation in children with previous abdominal surgery[J].J Pediatr Surg,2000,35(2):334-337.
14 Tiryaki T,Livanelioglu Z,Atayurt H.Eventration of the diaphragm[J].Asian J Surg,2006,29(1):8-10.DOI:10.1016/S1015-9584(09)60285-2.
15 马立东,李春雷,周福金,等.腹腔镜下膈肌折叠术治疗小儿先天性右侧膈膨升的疗效分析[J].临床小儿外科杂志,2015,14(4):307-309.DOI:10.3969/j.issn.1671-6353.2015.04.016. Ma LD,Li CL,Zhou JF,et al.Case analysis of the effectiveness of laparoscopic diaphragmatic plication to treat the children with congenital right-sided diaphragm eventration[J].J Clin Ped Sur,2015,14(4):307-309.DOI:10.3969/j.issn.1671-6353.2015.04.016.
16 马丽霜,张悦,刘树立,等.腔镜手术治疗新生儿及婴幼儿膈肌发育缺陷[J].临床小儿外科杂志,2013,12(2):103-106.DOI:10.3969/j.issn.1671-6353.2013.02.008. Ma LS,Zhang Y,Liu SL,et al.Study of laparoscopic operation in treatment of neonatal and infant diaphragmatic defects[J].J Clin Ped Sur,2013,12(2):103-106.DOI:10.3969/j.issn.1671-6353.2013.02.008.
17 王贤书,杨志国,岳芳,等.胸腔镜下手术治疗婴幼儿胸腹裂孔疝29例[J].临床小儿外科杂志,2017,16(1):37-40.DOI:10.3969/j.issn.1671-5363.2017.01.009. Wang XS,Yang ZG,Yue F,et al.Efficacies of video-assisted thoracoscopic repair of 29 infants with pleuroperitoneal hiatus hernia[J].J Clin Ped Sur,2017,16(1):37-40.DOI:10.3969/j.issn.1671-5363.2017.01.009.
18 吴阶平,裘法祖.黄家驷外科学[M].北京:人民卫生出版社,2000:1495-1496. Wu JP,Qiu FZ.Huang Jiasi Surgery[M].Beijing:People’s Medical Publishing House,2000:1495-1496.
19 张金哲,潘少川,黄澄如.实用小儿外科学[M].杭州:浙江科学技术出版社,2003:369-374. Zhang JZ,Pan SC,Hang CR.Practical Pediatric Surgery[M].Hangzhou:Zhejiang Science and Technology Publishing House,2003:369-374.
20 Liem NT.Thoracoscopic approach in management of congenital diaphragmatic hernia[J].Pediatr Surg lnt,2013,29(10):1061-1064.DOI:10.1007/s00383-013-3394-5.
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备注/Memo
收稿日期:2018-04-23。
基金项目:河北省医学科学研究重点课题计划（编号：20170383）