胸腔镜与开胸手术治疗婴幼儿先天性膈膨升的对比研究

Comparison of thoracotomy versus thoracoscopy in the treatment of diaphragmatic eventration in children

目的比较开胸与胸腔镜手术治疗婴幼儿先天性膈膨升的疗效,总结胸腔镜手术治疗婴幼儿先天性膈膨升的的经验。方法回顾性分析2012年3月至2018年3月由河北省儿童医院收治的87例婴幼儿膈膨升患儿的临床资料,按手术方式分为开胸组与胸腔镜组,分析比较两组患儿年龄、性别、体重、发病侧别、膈肌抬高肋单元、手术时间、术后呼吸机支持时间、胸腔闭式引流天数、住院天数和术后并发症等情况。结果两组患儿年龄、性别、体重、发病侧别、膈肌抬高肋单元等基本特征比较差异无统计学意义( P >0.05)。开胸组手术时间平均为(90.71±2.89)min,胸腔镜组为(78.81±3.48)min,胸腔镜组手术时间缩短( t =1.924, P =0.01)。开胸组术后呼吸机支持时间平均为(12.17±2.07)h,胸腔镜组为(5.71±0.89)h,胸腔镜组呼吸机支持时间短于开胸组( t =2.960, P =0.0036);开胸组胸腔闭式引流时间平均为(3.07±0.12)d,胸腔镜组为(1.85±0.23)d,胸腔镜组胸腔闭式引流时间短于开胸组( t = 11.500 , P <0.001);开胸组术后住院天数平均为(10.57±0.19)d,胸腔镜组为(8.08± 0.14 )d,胸腔镜组住院天数短于开胸组( t =10.530, P <0.001)。胸腔镜组瘢痕恢复程度优于开胸组,随访3个月至3年,均无复发。结论与开胸手术相比,胸腔镜具有手术打击小、恢复快、住院时间短、瘢痕小等优势,手术疗效确切、安全有效。

Objective To compare the efficacy of thoracotomy versus thoracoscopy and summarize the experiences of thoracoscopy in the treatment of congenital diaphragmatic eventration (CDE) in infants. Methods From March 2012 to March 2018,retrospective analysis were performed for the clinical data of 87 CDE cases.According to operative approaches,they were divided into thoracotomy and thoracoscope groups.Two groups were compared in terms of age,gender,weight,affected sideness,degree of diaphragmatic elevation,operative duration,postoperative ventilator support length,chest closed drainage duration,hospitalization stay and postoperative complications. Results No statistically significant inter-group difference existed in age,gender,weight,affected sideness or degree of diaphragmatic elevation ( P >0.05).The operative duration of thoracoscopy group was longer than that of thoracotomy group[(90.71±2.89) vs .(78.81±3.48) min]( t =1.924, P =0.01);postoperative ventilator support time shorter[(5.71±0.89 vs .12.17±2.07 hours)]( t =2.960, P =0.0036);closed thoracic drainage duration shorter[(1.85±0.23) vs .(3.07±0.12) days]( t =11.500, P <0.001);hospital stay shorter[(8.08±0.14) vs .(10.57±0.19) days]( t =10.530, P <0.001).There were three wounds (each about 0.7 cm long) and the scars were smaller in thoracoscopy group than those in thoracotomy group.Both groups were followed up for 3 months to 3 years without recurrence. Conclusion As compared with thoracotomy,thoracoscopy offers the advantages of small operative shock,a quicker recovery,a shorter hospitalization stay and minimal scar.