腔镜技术在小儿肿瘤切除手术中的应用及技巧探讨

Application and skill exploration of laparoscopic and thoracoscopic technology in pediatric tumor resection

目的探讨腔镜切除小儿肿瘤的可行性、临床效果、操作技巧与应用前景等,总结临床经验。方法回顾性收集2009年1月至2016年12月经胸腔镜、腹腔镜治疗的221例肿瘤患儿作为研究对象,分析治疗效果。结果221例肿瘤患儿中胸腔镜切除肺及纵膈肿瘤53例,腹腔镜切除腹腔、盆腔及腹膜后肿瘤168例。其中2例腹膜后肿瘤中转开腹手术;5例回盲部肿瘤,33例卵巢囊肿及19例卵巢畸胎瘤腹腔镜探查后经脐部拖出切除;其余手术均在腔镜下完成。术中无副损伤、无输血,术后Trocar口感染9例,瘢痕疙瘩5例;术后住院时间平均(5±1.6)d。术后随访发现2例肺囊肿出现复发,行2次手术切除后治愈;1例肠系膜淋巴管瘤出现黏连性肠梗阻,保守治疗后好转;1例膀胱横纹肌肉瘤术后半年死亡;1例腹膜后未成熟畸胎瘤化疗后死亡;其余恶性肿瘤患儿生存良好,恶性肿瘤生存率为80%(8/10)。结论腔镜切除小儿肿瘤就安全可行的;囊性肿瘤抽吸减压后经脐部拖出操作便捷、创伤小,囊实性肿瘤可以减压后拖出切除,也可全腔镜下切除;小的实性肿瘤不论良性、恶性均可腔镜更好切除;瘤体较大人实性肿瘤要适时中转开放手术。

Objective To explore the feasibility,clinical value,operative skill and application prospect of laparothoracoscopic technology in the resection of pediatric tumor and sum up the experiences.Methods A retrospective analysis was conducted for the clinical data of 221 patients undergoing tumor resection by laparoscopy/thoracoscopy from January 2009 to December 2016.Results All pediatric tumor resections were operated through mini-invasively successfully,including thoracoscopic lung and mediastinum tumor resections(n=53)and laparoscopic abdominal,pelvic and retroperitoneal tumor resections(n=168)and retroperitoneal tumor converting into open surgery(n=2).Ileocecal tumors(n=5),ovarian cyst(n=33)and ovarian teratoma(n=19)were resected and extracted through navel.There was no onset of collateral trauma or blood transfusion.Infections(n=9)and keloids(n=3)occurred at the Trocar incision.Discharge occurred smoothly at 5.9±3.1 days after operation.During follow-ups,two recurrent cases of pulmonary cyst were cured after re-operation.Two cases of mediastinal neuroblastoma receoved supplemental chemotherapy after surgery and both survived decenely.A case of postoperatibe adhesive intestinal obstruction,which received conservative treatment,occurred in a patient with mesenteric lymphangioma.After chemotherapy,another case of retroperitoneal immature teratoma died.Other children of malignant tumors survived decently and the survvial rate of malignant tumor was 80%(8/10).Conclusion Laparothoracoscopic resection of pediatric tumor is both safe and reliable.Extracting cystic tumor through navel after suction may simplify operative procedures.Cystic-solid tumor can be resected under laparoscopy or thoracoscopy.Small solid tumor,benign or malignant,can be resected under laparoscopy or thoracoscopy and malignant tumor is not absolute contraindications of mini-invasive surgery.