单孔电视胸腔镜在单纯性创伤性膈疝中的治疗分析

The treatment of single-portthoracoscopic in simple traumatic diaphragmatic hernia

目的探讨单孔电视胸腔镜在单纯性创伤性膈疝中的治疗及应用价值。方法回顾性分析解放军第175医院2008年3月至2014年3月78例单纯性创伤性膈疝治疗的临床资料,男52例,女26例,年龄18~62岁,平均年龄(35.2±8.5)岁,将患者随机分为单孔胸腔镜组40例(采用单孔胸腔镜手术)和剖胸组38例(剖胸手术还纳疝入的腹腔器官)。采用不可吸收线间断缝合修补膈肌缺损,缺损无法缝合修补,采用补片修补。主要观察指标包括手术切口长度、术中出血量、手术时间、拔除胸腔引流管时间和住院时间。结果 78例患者术后恢复良好,随访3~36个月,平均18个月,未发现膈疝复发。与剖胸组比较,单孔胸腔镜组手术切口长度短[(3.1±1.3)cm vs(7.2±3.7)cm,P<0.05],术中出血量少[(51.0±6.3)m L vs(80.4±4.9)m L,P<0.05],手术时间短[(70.0±15.1)min vs(125.4±18.3)min,P<0.01],拔除胸腔引流管时间短[(2.7±1.3)d vs(5.1±0.8)d,P<0.05],住院时间短[(14.0±1.3)d vs(22.5±1.6)d,P<0.01]。结论单孔胸腔镜治疗单纯性创伤性膈疝创伤小、术后恢复快,改善了创伤性膈疝患者术后恢复质量,是治疗单纯性创伤性膈疝的有效手术方式。

Objective To explore the treatment and application value of single-port thoracoscopic in simple traumatic diaphragmatic hernia. Methods Clinical data of 78 patients with simple traumatic diaphragmatic hernia receiving surgical treatment from March 2008 to March 2014 were retrospective analysed. There were 52 males and 26 females,aged between 18 and 62 years old[mean（ 35. 2±8. 5） years]. They were randomly divided into single-port thoracoscopic surgery group and thoracotomy surgery group.40 patients repaired under single thoracoscopy. 38 patients repaired under the open heart surgery. Abdominal organs were pulled back through diaphragmatic defect which was then repaired with interrupted non-absorbable sutures or mesh. The main indicators included the incision length,intraoperative blood loss,operation time,time of drainage,duration of hospital stay were observed. Results 78 patients were all repaired successfully. Follow-up for 3-36 months（ mean 18 months） found no severe ostoperative complications or recurrence. Compared with the horacotomy surgery group,the single-port thoracoscopic surgery group in the wound length shortened[（ 3. 1±1. 3） cm vs（ 7. 2±3. 7） cm,P〈0. 05]; The amount of blood loss during operation was significantly lower[（ 51. 0±6. 3） mL vs（ 80. 4±4. 9） mL,P〈0. 05]; The operation time was significantly shorter [（ 70. 0±15. 1） min vs（ 125. 4±18. 3） min,P〈0. 01]; The time of drainage was significantly shorter[（ 2. 7± 1. 3） d vs（ 5. 1± 0. 8） d,P〈0. 05]; The duration of hospital stay was significantly shorter[（ 14. 0±1. 3） d vs（ 22. 5± 1. 6） d,P〈0. 01]. Conclusion Single-port thoracoscopic repair of simple traumatic diaphragmatic hernia has dvantages of minimal invasion,quick recovery,improving the quality of postoperative recovery and being an effective option for the treatment of traumatic iaphragmatic hernia.