电视胸腔镜在小儿胸部外科手术中的应用

Application of thoracoscope in pediatric surgery

目的探讨电视胸腔镜手术在小儿胸部疾病中应用的可行性、实用性及安全性。方法从1998年4月到2006年4月556例行电视胸腔镜手术,年龄从1个月到18岁,其中诊断性手术124例,包括:纵隔胸膜活检74例,肺活检41例,椎体活检9例。治疗性手术432例,包括:纵隔肿瘤切除术93例,脓胸56例,乳糜胸21例,漏斗胸224例,心包开窗15例。贲门失弛缓症9例,胸外伤5例,肺囊性病5例,胸腹裂孔疝4例。麻醉:双腔单肺通气4例,单腔单肺通气16例,单腔双肺通气控制呼吸58例,人工气胸控制流量混合通气478例。结果3例活检未得出结论;5例中转开胸占0.9%,551例顺利完成手术;全组无手术死亡。术中、术后并发症5例占0.9%。结论电视胸腔镜手术可以涉及大部分小儿胸外科手术,而且创伤小、恢复快、安全可行应大力推广。人工气胸混合通气是目前条件下小儿胸腔镜手术麻醉的最佳选择。

Objective To discuss the application of the video assisted lhoracic operation in pediatric surgery. Methods Thoracoscopic surgery was performed on 556 patienls at the age of 30 days to 18 years old from April 1998 to April 2006. Diagnostic surgery included biopsy of mediastirml pleura, in 74 cases, lung biopsy in 41, and biopsy of vertebral body in 9. Surgery for treatment included excision of mediastinal tumor in 93, emphysema in 56, chylothorax in 21, funnel chest in 224, pericardium open in 15, cardiac actmlasia in 9, chest trauma in 5, cystic disease of the lung in 5, and pleuroperitional foramen hernia in 4. General anes- thesia included one-lung ventilation with bilumen tube in 4 cases, one-lung ventilation with branch intubations in 16, one-lung ventilation with bilumen tube to control respiration in 58, one-lung ventilation with branch intubations for artificial pneurr^thomx in 478. Results Only 5 cases was converted to open surgery （0. 9% ）, the others were successfully treated, no operative mortality and .severe postoperative complications found. Causions The video-assisted thoracic surgery is practically efficacious in most pediatric patients with minimal trauma and fast recovery. One-lung ventilation with bilumen tube for artificial pneurnothorax is the best choice for anaesthesia in this operation.