Hou Peimin,Wang Dongming,Zhang Qiangye,et al.Application and skill exploration of laparoscopic and thoracoscopic technology in pediatric tumor resection[J].Journal of Clinical Pediatric Surgery,2019,18(04):277-281.[doi:10.3969/j.issn.1671-6353.2019.04.006]
腔镜技术在小儿肿瘤切除手术中的应用及技巧探讨
- Title:
- Application and skill exploration of laparoscopic and thoracoscopic technology in pediatric tumor resection
- Keywords:
- Neoplasms; Laparoscopy; Thoracoscopy; Surgical Procedures; Operative
- 分类号:
- R729;R616.5
- 摘要:
- 目的 探讨腔镜切除小儿肿瘤的可行性、临床效果、操作技巧与应用前景等，总结临床经验。方法 回顾性收集2009年1月至2016年12月经胸腔镜、腹腔镜治疗的221例肿瘤患儿作为研究对象，分析治疗效果。结果 221例肿瘤患儿中胸腔镜切除肺及纵膈肿瘤53例，腹腔镜切除腹腔、盆腔及腹膜后肿瘤168例。其中2例腹膜后肿瘤中转开腹手术；5例回盲部肿瘤，33例卵巢囊肿及19例卵巢畸胎瘤腹腔镜探查后经脐部拖出切除；其余手术均在腔镜下完成。术中无副损伤、无输血，术后Trocar口感染9例，瘢痕疙瘩5例；术后住院时间平均（5±1.6）d。术后随访发现2例肺囊肿出现复发，行2次手术切除后治愈；1例肠系膜淋巴管瘤出现黏连性肠梗阻，保守治疗后好转；1例膀胱横纹肌肉瘤术后半年死亡；1例腹膜后未成熟畸胎瘤化疗后死亡；其余恶性肿瘤患儿生存良好，恶性肿瘤生存率为80%（8/10）。结论 腔镜切除小儿肿瘤就安全可行的；囊性肿瘤抽吸减压后经脐部拖出操作便捷、创伤小，囊实性肿瘤可以减压后拖出切除，也可全腔镜下切除；小的实性肿瘤不论良性、恶性均可腔镜更好切除；瘤体较大人实性肿瘤要适时中转开放手术。
- Abstract:
- Objective To explore the feasibility,clinical value,operative skill and application prospect of laparothoracoscopic technology in the resection of pediatric tumor and sum up the experiences.Methods A retrospective analysis was conducted for the clinical data of 221 patients undergoing tumor resection by laparoscopy/thoracoscopy from January 2009 to December 2016.Results All pediatric tumor resections were operated through mini-invasively successfully,including thoracoscopic lung and mediastinum tumor resections (n=53) and laparoscopic abdominal,pelvic and retroperitoneal tumor resections (n=168) and retroperitoneal tumor converting into open surgery (n=2).Ileocecal tumors (n=5),ovarian cyst (n=33) and ovarian teratoma (n=19) were resected and extracted through navel.There was no onset of collateral trauma or blood transfusion.Infections (n=9) and keloids (n=3) occurred at the Trocar incision.Discharge occurred smoothly at 5.9±3.1 days after operation.During follow-ups,two recurrent cases of pulmonary cyst were cured after re-operation.Two cases of mediastinal neuroblastoma receoved supplemental chemotherapy after surgery and both survived decenely.A case of postoperatibe adhesive intestinal obstruction,which received conservative treatment,occurred in a patient with mesenteric lymphangioma.After chemotherapy,another case of retroperitoneal immature teratoma died.Other children of malignant tumors survived decently and the survvial rate of malignant tumor was 80% (8/10).Conclusion Laparothoracoscopic resection of pediatric tumor is both safe and reliable.Extracting cystic tumor through navel after suction may simplify operative procedures.Cystic-solid tumor can be resected under laparoscopy or thoracoscopy.Small solid tumor,benign or malignant,can be resected under laparoscopy or thoracoscopy and malignant tumor is not absolute contraindications of mini-invasive surgery.
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备注/Memo
收稿日期:2018-10-30。
基金项目:国家自然科学基金（编号：81704192）
通讯作者:李爱武,Email:liaiwuxie@aliyun.com