胸腔镜下三点反向膈肌折叠术治疗小儿右侧膈膨升

Thoracoscopic three-point inversed plication technique for right-sided diaphragmatic eventration in children

目的 探讨胸腔镜下三点反向膈肌折叠术治疗小儿膈膨升的初步经验.方法 回顾性分析2013年1月至2017年1月采用胸腔镜下三点反向膈肌折叠术的简易快速缝合法治疗10例右侧膈膨升患儿（胸腔镜组）的临床资料,并与2012年1月至2013年11月中采用常规开放膈肌折叠术治疗9例右侧膈膨升患儿（常规组）的临床资料进行对比.胸腔镜组男6例,女4例;入院年龄为生后1 h至4岁,平均306 d.其中,生后28 d以内的儿童6例,6月龄至4岁4例.体重为（6.3±5.7）kg,范围2.5～17.0 kg.10例均采取三孔法,在胸腔镜下行膈肌折叠术.常规组男7例,女2例;平均年龄为325 d,体重为（6.5±5.4）kg.两组术前一般情况比较,差异均无统计学意义,具有可比性.结果胸腔镜组10例均顺利经胸腔镜完成手术.术中出血少,无手术并发症,无中转开胸患儿.手术时间为（36.7±8.1）min,时间范围为25～50 min;术中出血量为（6.5±1.5）ml;术后（6.4±1.2）d出院,范围为5～10 d.常规组手术时间为（125.5±15.5）min,时间范围为90～150 min;术中出血量为（7.5±1.8）ml;术后住院时间为（6.6±1.5）d.两组比较,除手术时间差异有统计学意义（P〈0.05）外,术中出血量和术后住院时间差异均无统计学意义（P〉0.05）.结论 胸腔镜下三点反向膈肌折叠术治疗小儿膈膨升是一个有效且可靠的技术,具有操作简单、手术时间短、效果确切等优点,有临床推广价值.

Objective To summarize our initial experience of simplified rapid suture method by using three-point inversed plication technique for diaphragmatic eventration in children.Methods The clinical data of a new simplified suture technique of right-sided diaphragmatic eventration in 10 cases （thoracoscopic repair group）from January 2013 to January 2017 was retrospectively analyzed and compared with the clinical data of 9 children of right-sided diaphragmatic eventration undergoing conventional open diaphragm plication from January 2012 to November 2013 （conventional open repair group）.In thoracoscopic repair group,there were 6 boys and 4 girls with a mean age of 306 days （1 day-4 years）and a mean weight of （2.5-17.0）（6.3±5.7）kg.Six were aged under 28 days and 4 were 6 months to 4 years.All patients completed thoracoscopic diaphragmatic plication successfully with three ports.In control group between January 2012 to December 2013,there were 7 boys and 2 girls with a median weight of （6.5±5.4）kg.No significant inter-group statistical differences existed prior to operation.Results A total of 10 patients were operated successfully using this new technique.The mean operative duration was （36.7 ± 8.1 ）min （range 25-50 min）.None required a conversion into open surgery.Operative blood loss was （6.5 ± 1 .5 ）ml and patient discharge occurred at 5-10 （mean 6.4±1 .2）days postoperatively.The operative duration of control group was 90-150 （mean 125.5 ± 15.5）min,operative blood loss （7.5 ± 1 .8）ml and patient discharge occurred at （6.6 ± 1 .5 ）days postoperatively.The average operative durations were different between two groups （P 〈0.05）.Mean blood loss and postoperative discharge time had no significant inter-group difference （P 〉 0.05 ）.Conclusions Thoracoscopic three-point inversed plication technique for pediatric diaphragmatic eventration has the advantages of reduced operative duration,simplicity and feasibility.Wider popularization is recommended.