[1]夏仁鹏,周崇高,李碧香,等.胸腔镜手术与开胸手术治疗Ⅲ型食管闭锁的对比研究[J].临床小儿外科杂志,2018,17(03):179-183.
　Xia Renpeng,Zhou Chonggao,Li Bixiang,et al.Comparative study of thoracoscopy and thoracotomy for the treatment of type Ⅲ esophageal atresia.[J].Journal of Clinical Pediatric Surgery,2018,17(03):179-183.
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胸腔镜手术与开胸手术治疗Ⅲ型食管闭锁的对比研究

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 第17卷 期数: 2018年03期 页码: 179-183 栏目: 专题讨论 出版日期: 2018-03-28
Title:
Comparative study of thoracoscopy and thoracotomy for the treatment of type Ⅲ esophageal atresia.
作者:
夏仁鹏; 周崇高; 李碧香; 等
湖南省儿童医院新生儿外科
Author(s):
Xia Renpeng; Zhou Chonggao; Li Bixiang; Wang Haiyang; Xu Guang; Zou Canjuan; Ma Tidong; Zhao Fan; Xiao Yong.
Department of Neonatal Surgery,Hunan Childrens Hospital,Changsha 410007,China.
Keywords:
Thoracoscopes;  Esophageal Atresia;  Tracheoesophageal Fistula;  Comparative Study
文献标志码:
A
摘要:
目的　比较胸腔镜手术与开胸手术治疗先天性食管闭锁并食管气管瘘的临床疗效。　方法　２０１１ 年６ 月至２０１５ 年７ 月间本院共收治１１２ 例先天性食管闭锁并食管气管瘘患儿，其中５４ 例行胸腔镜手术（胸腔镜组） ，５８ 例行开胸手术（ 开胸组） ，对两组患者的一般资料、围手术期情况和术后
效果进行比较。　结果　胸腔镜组５４ 例中５１ 例完成一期食管气管瘘修补＋ 食管吻合术，３ 例中转开胸手术，术后４ 例放弃治疗。开胸组５８ 例中５７ 例一期完成食管吻合术，１ 例术中见两盲端相距４ ｃｍ，需先行胃造瘘术，家长放弃治疗，术后３ 例放弃治疗。手术时间胸腔镜组为（ １３８ ± ３０） ｍｉｎ，开胸组为（１２２ ±２３） ｍｉｎ，经统计学分析差异有意义（ ｔ ＝ ３． ２０６， Ｐ ＜ ０． ００１） ；术后呼吸机使用时间胸腔镜组为（１． ６８ ±０． ４２） ｄ，开胸组为（１． １２ ±０． ２３） ｄ，两组比较差异有统计学意义（ ｔ ＝ ９． ０００；Ｐ ＜ ０． ００１） ；住院天数胸腔镜组平均为（２０． ６３ ±３． ５４） ｄ，开胸组平均为（１９． ７５ ± ２． ８７） ｄ，两组对比差异无统计学意义（ ｔ ＝１． ４６７，Ｐ ＝０． ０７４） 。胸腔镜组５４ 例中９ 例吻合口漏（ １６． ７％ ） ，５ 例吻合口狭窄（ ９． ３％ ） ，１ 例食管气管瘘复发（１.９％ ） 。开胸组５８ 例中６ 例吻合口漏（１０． ３％ ） ，１０ 例（１７． ２％ ）吻合口狭窄，２ 例（３． ４％ ） 食管气管瘘复发，两组比较差异无统计学意义（ ｘ２ ＝ ０． １４３，Ｐ ＝ ０． ７０５） 。　结论　胸腔镜手术治疗先天性食管闭锁并食管气管瘘是安全可行的，结果与开胸手术相当，但远期效果仍需进一步随访。
Abstract:
ObjectiveTo evaluate the clinical results of thoracoscopy versus thoracotomy for esophageal atresia(EA) and tracheoesophageal fistula(TEF).MethodsThere were 112 cases with EA and TEF from June 2011 to July 2015.54 patients who were underwent thoracoscopy while other 58 underwent thoracotomy.General data with perioperative and postoperative outcomes were retrospectively analyzed between the two groups.ResultsThoracoscopy was completed in 51 cases and there were 3 patients turn to open thoracotomy surgery,4 patients given up postoperative.And 57 cases underwent throughpleural esophageal anastomosis and 1 patient was adjourned in operation because of excessively long gap and needed to do gastrostomy first,another 3 patients relatives given up postoperative.The mean operative time was 138±30 min for thoracoscopyversus 122±23 min for open thoracotomy surgery,There were statistical significance（t=3.206,P<0.001）.The mean time to extubation was 1.68±0.42 versus 1.12±0.23 days.There were statistical significance（t=9.000,P<0.001）；The mean length of inhospital stay was 20.63±3.54 versus 19.75±2.87 days,with no statistical significance (t=1.467,P=0.074).The anastomotic leak rate was 16.7% versus 10.3%.The stricture rate was 9.3% versus 17.2%.The recurrent rate of TEF was 1.9% versus 3.4%.There were no statistical significance(χ2=0.143，P=0.705).ConclusionThe thoracoscopy technique is safe and feasible for typeⅢ EA/TEF,but need to further follow up for the longterm effect.
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