胸腔镜辅助小切口胸椎半椎体切除的初步疗效

Preliminary clinical outcomes of video-assisted minithoracotomy for the thoracic hemivertebral excision

目的探讨电视胸腔镜辅助下小切口经胸前路行半椎体切除的可行性及优点。方法胸椎半椎体畸形患者7例,男3例,女4例,年龄12～17岁;T103例,T112例,T122例。全麻后在半椎体侧胸廓腋中线7～8(或8～9)肋间隙作一锁孔建立观察通道插入胸腔镜;在与半椎体同水平面所对应的肋间隙的腋中线至腋后线做5～7cm切口并经肋间隙开胸。暴露半椎体后在胸腔镜监视下切除半椎体及相邻的椎间盘。关胸后一期或二期经后路切除半椎板及附件,并应用椎弓根螺钉矫形、固定和植骨融合。结果矫形后冠状位Cobb角由平均41°减为21°,矢状位由平均36°减为15°。术后患者均未出现呼吸困难、肺部感染及双下肢神经症状。短期随访患者切口瘢痕小,无肋间神经痛,脊柱融合及内固定物良好。结论经电视胸腔镜辅助下小切口半椎体切除治疗胸椎半椎体,在保证前、后联合手术的矫正率同时可有效减少手术创伤及手术瘢痕。

Objective To investigate the feasibility and the advantage of the thoracic hemivertebral excision with thoracoscope. Methods The series consisted of 7 cases, including 3 males and 4 females with average age of 13.7 years, ranging from 12 to 17 years. The hemivertebrae was located at the tenth thoracic level in 3 patients, the 1 lth thoracic level in 2 patients, the 12th thoracic level in 2 patients. The portal for observation by thoracoscope was placed at T7 or T8 intercostal space in the middle axillary line on the hemivertebrae side after the general anesthesia; 5 to 7cm long skin incision was made from the middle to the posterior axillary line at the same level of the hemivertebra, and the thorax was exposed through the intercostal space. The hemivertebrae were exposed and excised. The pleura and the chest wall were closed, and the hemilaminectomy and posterior correction were done on the same or second stage. Results The mean preoperative coronal curve was 41 °, and was reduced to 21 ° post-operatively; the mean Cobb＇s angle, from 36° to 15° after the surgery. There was no dyspnea, pneumonia or neural compromise found postoperatively. At a short-term follow up, no intercostal neuralgia, the instrumentation failure and delayed fusion were discovered. Conclusion This study shows that the video-assisted minithoracotomy combined with posterior instrumentation is a safe and effective treatment for the congenital thoracic scoliosis. Additionally, it is less invasive with smaller incision scar.