胸腔镜与开胸手术治疗小儿肺包虫病的临床比较

Clinical comparison of video-assistant thorascope and thoracotomy operation in children with pulmonary hydatid

目的比较在电视胸腔镜下与传统开胸行小儿肺包虫内囊摘除术的临床疗效。方法 2006年1月至2012年6月收治小儿肺包虫病患者76例,其中44例在电视胸腔镜下行包虫内囊摘除术(胸腔镜组),28例开胸行内囊摘除术(开胸组),2例放弃手术,2例误诊为胸腔积液。对两种手术方法的特点、手术时间、围术期并发症发生率、住院天数、住院费用等方面进行比较。结果两组手术时间、比较,差异无统计学意义(P>0.05);胸腔镜组住院时间、住院费用、术中出血量少于开胸组(P<0.05);并发症的比较:术后漏气、患侧肺不张等并发症发生率两组比较差异无统计学意义(P>0.05),术后体温升高、切口感染发生率,胸腔镜组明显少于开胸组(P<0.05);3年远期随访,两组比较,复发率差异无统计学意义(P>0.05)。结论电视胸腔镜下小儿肺包虫内囊摘除术已成为一种新的手术方式,与传统开胸手术相比,该术式创伤小、术中出血少、术后引流量少、疼痛轻、并发症发生率低等优点,住院费用低,值得广泛推广开展。

Objective To compare with the clinical efficacy of video-assistant thorascope （ VATS ） and the traditional open-chest in children with echinococcosis pulmonum. Methods From January 2006 to June 2012, 76 patients with echinococcosis pulmonum, and 44 children within the thoracoscopi excision of hydatid cyst （ VATS group ）, 28 children within the open heart removal of the internal capsule down surgery （ thoracotomy group ）, 2 children gave up surgery, 2 children were misdiagnosed as pleural effusion. The characteristics of the two surgical methods, operative time, perioperative complications, length of stay, hospital costs were compared. Results The result of operative time VATS group compared with the thoracotomy group no significant difference （ P ＆gt; 0.05 ）. The length of stay and blood loss VATS group less than the thoracotomy group （ P ＆lt; 0.05 ）. Comparison of complications： leak after the operation, ipsilateral atelectasis incidence of complications were no significant difference between the two groups （ P ＆gt; 0.05 ）, postoperative fever, wound infection rate of VATS group were significantly less than the thoracotomy group （ P ＆lt; 0.05 ）. VATS group hospitalization costs lower than thoracotomy group （ P ＆lt; 0.05 ）, 3-year long-term follow-up, the two groups, no significant difference in relapse rate （ P ＆gt; 0.05 ）. Conclusions VATS pediatric pulmonary hydatid cyst excision has become within a new surgical procedure, compared with traditional open heart surgery, under the surgical trauma, less bleeding, less postoperative drainage, less pain, fewer complications and lower hospital costs, it is widely carried out.