胸腔镜下连续与间断折叠缝合膈肌治疗小儿先天性膈膨升的对比研究

Efficacy comparison of running versus interrupted suturing for thoracoscopic repair of congenital diaphragmatic eventration in children

目的回顾性对比分析胸腔镜下连续与间断折叠修补膈肌治疗小儿先天性膈膨升（CDE）的效果。方法回顾性分析2010年1月至2014年5月收治的21例行胸腔镜膈肌折叠术CDE患儿的临床资料。采用连续缝合折叠膈肌12例，为连续缝合组；采用间断缝合进行手术9例，为间断缝合组。连续缝合组，男9例，女7例；平均年龄（19．5±8．7）月；平均体重（12．5±4．2）kg；左侧膈膨升5例，右侧膈膨升7例。间断缝合组，男7例，女2例；平均年龄（23．1±9．5）月；平均体重（13．8±5．7）kg；左侧膈膨升3例，右侧膈膨升6例。两组术前一般情况比较，差异均无统计学意义，具有可比性。所有患儿术前膈肌均抬高≥2个肋间（3．5～6．5个肋间，平均4．75个肋间）。结果连续缝合组和间断缝合组的平均手术时间分别为（33±17）min和（75±21）min，差异有统计学意义（P〈0．01）；平均出血量分别为（7．5±1．5）ml和（8．7±2．1）ml，差异无统计学意义（P=0．87）。两组患儿胸腔引流时间均为2～3d，术后住院时间为4～5d。术后随访1．2～4．7g，平均（3．2±1．5）年，仅连续缝合组术后复发1例，再次行开胸手术后治愈。结论与间断缝合折叠修补膈肌相比，胸腔镜下连续缝合折叠修补膈肌治疗CDE是一种安全、有效、操作简便的手术方法，并可显著缩短手术时间。

Objective To compare the efficacies of running versus interrupted suturing for thoracoscopic repair of congenital diaphragmatic eventration （CDE） in children. Methods A total of 21 CDE children were repaired under thoracoscopy from January 2010 to May 2014. According to different sutures for thoracoscopic repair, they were divided into Group 1 （running suture line） （n = 12） and Group 2 （interrupted suture） （n = 9）. In Group 1, there were 9 boys and 7 girls with a mean age of （19. 5 ± 8.7） months and a mean weight of （12. 5 ± 4. 2） kg. There were left diaphragmatic eventration （n = 5） and right diaphragmatic eventration （n = 7） ; In Group 2, there were 7 boys and 2 girls with a mean age of （23.1 ± 9. 5） months and a mean weight of （13.8± 5.7） kg, There were left diaphragmatic eventration （n = 3）, right diaphragmatic eventration （n = 3） and right diaphragmatic eventration （n = 6）. No statistically significant inter-group differences existed prior to operation. Results No detectable difference existed between preoperative profiles. The average operative durations were different （33 ± 17 vs 75 ± 21 min; P〈0. 01）. Other variables were similar between two groups （7. 5 ± 1.5 vs 8.7 ± 2. 1 ml）. The drainage time was 2/3 days and the mean postoperative hospital stay 4/5 days. The mean follow-up period was （3. 2 ± 1.5） （1.2-4. 7） years. Only 1 case recurred in Group 1. Conclusions As compared with an interrupted suture, thoracoscopic repair of CDE via a running suture is safe, reliable, technically convenient and efficacious for diaphragmatic placation.