不同手术方式治疗食管闭锁的对比分析

Comparative analysis of different surgical methods for treating esophageal atresia

目的探讨胸腔镜与开胸手术对食管闭锁的疗效差异.方法选取福建省妇幼保健院儿外科2015年2月至2018年5月手术治疗的31例Ⅲ型食管闭锁患儿的临床资料,根据采用手术方式的不同分为胸腔镜组(15例)和开胸组(16例).对比2组的手术时间、术中出血量、术后胸腔引流时间、术后住院时间及术后并发症.结果胸腔镜组手术时间为(181.33±13.86)min,开胸组手术时间(139.06±10.98)min,胸腔镜组手术时间较开胸组长,2组手术时间比较差异有统计学意义(t=9.44,P=0.000);腔镜组术中出血量(3.07±0.96)mL,开胸组术中出血量(5.06±1.12)mL,腔镜组术中出血量少于开胸组,2组术中出血量比较差异有统计学意义(t=-5.29,P=0.000);腔镜组术后胸管留置时间(11.67±1.34)d,开胸组留置时间(12.25±1.06)d,2组术后胸管留置时间比较差异无统计学意义(t=-1.34,P=0.19);胸腔镜组术后住院时间(15.20±0.94)d,开胸组术后住院时间(16.00±0.96)d,2组差异有统计学意义(t=-2.33,P=0.027);胸腔镜组中5例术后发生吻合口瘘(33.33%),吻合口狭窄6例(40.00%),开胸组中4例术后发生吻合口瘘(25.00%),5例发生吻合口狭窄(31.25%),2组吻合口瘘、吻合口狭窄的术后发生率比较,差异无统计学意义(P>0.05).结论与开胸手术相比,胸腔镜治疗食管闭锁具有手术切口小、术中出血少、胸廓畸形少、术后住院时间短等优点,是安全有效的,但需要手术者熟练的胸腔镜操作经验.

Objective To investigate the difference in the clinical efficacy by thoracoscopy or thoracotomy for treating esophageal atresia.Methods Thirty-one cases of type-Ⅲesophageal atresia undergoing surgical treatment from February 2015 to May 2018 at the Department of Pediatric Surgery of Fujian Provincial Maternity and Children′s Hospital were included,and according to the different surgical methods they were divided into thoracoscopic group(15 cases)and thoracotomy group(16 cases).The operation duration,blood loss,postoperative chest drainage time,posto-perative hospital stay and postoperative complications were analyzed between 2 groups.Results The mean time of operation was(181.33±13.86)min in the thoracoscopic surgery group and(139.06±10.98)min in the thoracotomy group,the thoracoscopic group had longer operation duration than thoracotomy group,and there was a significant difference in operation duration between two groups(t=9.44,P=0.000);mean blood loss was(3.07±0.96)mL in the thoracoscopic surgery group and(5.06±1.12)mL in the thoracotomy group,the thoracoscopic group had less amount of blood loss than thoracotomy group,and there was a significant difference in blood loss between two groups(t=-5.29,P=0.000);mean postoperative chest drainage time was(11.67±1.34)d in the thoracoscopic group and(12.25±1.06)d in the thoracotomy group,and there was no significant difference in postoperative chest drainage time between two groups(t=-1.34,P=0.19);mean time of postoperative hospitalization time was(15.20±0.94)d in the thoracoscopic group and(16.00±0.96)d in the thoracotomy group,and there was a significant difference in the postoperative hospitalization time between two groups(t=-2.33,P=0.027);the anastomotic leak rates were 33.33%(5 cases)versus 25.00%(4 cases)with closed or open approaches,respectively;anastomotic stricture rates were 40.00%(6 cases)versus 31.25%(5 cases)with closed or open approaches,respectively.There was no significant difference in postoperative incidence of anastomotic fistula and anastomotic stenosis between two groups.Conclusions Compared with thoracotomy in the treatment of esophageal atresia,thoracoscopic approach has smaller incision and less bleeding,less chest deformity,short hospital stay postoperatively,so it is safe and effective.However,the surgeon must have experience in doing thoracoscopic operation.