电视胸腔镜与传统开胸手术在小儿肺叶切除中的比较

Video-assisted thoracoscopic vs conventional thoracotomy lobectomy in infants and yong children

目的对比观察电视胸腔镜手术(video-assisted thoracospic surgery,VATS)与传统开胸手术在小儿肺叶切除术中的临床效果。方法 2012年6月至2015年12月本院共收治61例需行肺叶切除的患儿,依照患儿病变情况及家属意愿分别采取了电视胸腔镜手术(VATS组)和开胸手术(开胸组)。VATS组22例中,14例在电视胸腔镜辅助下行小切口肺叶切除术,8例在全胸腔镜下行肺叶切除术;开胸组39例接受传统开胸肺叶切除术。比较两组手术切口、手术时间、术中出血量、输血比例、术后使用呼吸机时间、引流量多于2 mL·kg^(-1)·d^(-1)的天数、术后重症监护室滞留时间、术后并发症的发生率,以及围手术期白细胞、C反应蛋白、降钙素原等指标。结果两组均顺利完成手术,无死亡及严重并发症。两组年龄、体重、发病部位以及病理改变无显著性差异(P>0.05);术后并发症的发生率元显著性差异(P>0.05);与传统开胸组相比,VATS组切口长度(2.87±1.04 cm vs 8.25±2.32 cm,t=-2.741,P=0.003)、手术时间(85.67±23.95 minuts vs 110.48±32.71 minuts,￡=-3.112,P=0.002)、术中出血量(80.00±45.40 mL vs 143.04±67.04 mL,t=-4.112,P=0.002)、输血比例(P=0.043)、引流量大于2 mL·kg^(-1)·d^(-1)的天数(3.66±1.74 d vs 6.26±3.59 d,t=-4.305,P=0.000)、术后重症监护室滞留时间大于24 h、呼吸机辅助通气时间大于12 h的例数均降低(P<0.05);术后第1 d胸腔镜组中白细胞(5.68±1.59×10~9/L vs 13.99±1.74×10~9/L,t=-4.325,P=0.002)、CRP(16.68±2.55 mg/L vs 25.63±4.67 mg/L,t=-6.613,P=0.000)以及PCT(1.40±0.61 ng/mL vs 6.61±3.17 ng/mL,t=-7.372,P=0.002),均低于传统开胸组(P<0.05)。结论与传统开胸组相比,VATS下行小儿肺叶切除术出血少,术后呼吸机使用时间、.ICU滞留时间短,应激性炎症反应弱,但对于降低并发症的发生率并元显著差异。

Objetive To compare the different clinical value of video-assisted thoracoseope surgery （VATS） and the conventional thoracotomy lobectomy in infants and yong children via observation. Methods Pulmonary lobectomies were carried on a total of 61 cases from June 2012 to December 2015. VATS lobectomy （VATS group） was carried on 22 cases, including video-assisted mini-thoracotomy lobectomy on 14 cases, and full thoracoscopic lobectomy on 8 cases. Conventional thoractomy （conventional group） was carried on 39 cases. The incision length, operation time, intraoperative bleeding volume, rate of blood transfusion, time for using breathing machine after operation, number of days for chest drainage volume greater than 2 mL·/kg^-1·d^-1 ,time for staying in ICU, incidence of complications, and the changes of white blood cells, C-reactive protein and serum procalcitonin during peri-operation. Results No severe complication and operative death was recorded. There was no significant difference on ages, body weight, sites, pathological changes, and incidence of complications between VATS group and conventional thoracotomy group （ P 〉 0.05 ）. There was statistical significance between VATS group and conventional thoracotomy group in incision length（2. 87 ±1.04 cm vs 8.25 ± 2. 32 cm , t = - 2. 741, P = 0. 003）, operation time （ 85.67 ± 23.95 minutes vs 110.48 ± 32. 71 minutes, t = - 3.112, P = 0. 002）, intraoperative bleeding volume （ 80. 00± 45.40 mL vs 143. 04±67.04 mL, t = - 4. 112, P = 0.002） , rate of blood transfusion was observed （ P = O. 043 ）, number of days for chest drainage volume greater than 2 ml/kg·d（3. 66±1.74 d vs 6. 26±3.59 d,t = -4. 305 ,P =0. 000）. In VATS group, number of cases with breathing machine after operation for more than 12 h, and cases in ICU time for more than 24 h were reduced in comparison with those in conventional thoraeotomy group （ P 〈 0. 05 ）. The levels of white blood cell （5.68 ± 1.59 ×10^9/L vs 13.99 ± 1.74×10^9/L,t =-4.325, P =0.002） ,CRP （16.68±2.55 mg/L vs 25.63±4.67 mg/L,t = -6.613,P=0.000） and PCT（1. 40± 0. 61 ng/mL vs 6.61 ± 3. 17 ng/mL, t = -7. 372,P = 0. 002） in VATS group were significantly lower than that in conventional thora- cotomy group. Conclusions Compared with the conventional thoraeotomy group, VATS group has characteristics of lower intraoperative bleeding volume, shorter time for using a ventilator and for duration in ICU, decreased postoperative irritability inflammation, and no significant difference in reducing the incidence of complications.