胸腔镜与传统开胸手术治疗儿童先天性肺隔离症的临床疗效对比

Clinical efficacy of thoracoscopy versus traditional thoracotomy in treatment of congenital pulmonary sequestration in children

目的对比分析胸腔镜手术与传统开胸手术治疗儿童先天性肺隔离症的临床疗效,探讨胸腔镜治疗儿童先天性肺隔离症的价值。方法回顾性分析2015年1月至2020年1月于重庆医科大学附属儿童医院心胸外科接受手术治疗的41例先天性肺隔离症患儿的临床资料,按手术方式分为开胸组和胸腔镜组。临床手术方式的选择由制定的开胸组及胸腔镜组患儿纳入标准决定。开胸组20例,其中男性12例,女性8例;年龄3 d至12岁8个月[(86.07±38.96)个月]。胸腔镜组21例,其中男性11例,女性10例;年龄4个月至11岁2个月[(99.06±57.38)个月]。对两组患儿随访5个月至5年,观察并对比分析两组患儿手术时间、术中出血量、胸腔引流时间、术后住院时间等手术指标以及病死率、复发率和并发症发生率等情况。结果两组患儿均顺利完成手术,无1例死亡及严重并发症发生。两组患儿年龄、体质量、发病部位差异无统计学意义(P>0.05),胸腔镜手术组中有1例中转开胸手术。胸腔镜组术中出血量、术后机械通气时间、胸腔引流时间、CCU滞留时间及住院时间均优于开胸组患儿(P<0.05),胸腔镜组手术时间较开胸组时间长(P<0.05)。结论胸腔镜手术与开胸手术均能有效治疗儿童先天性肺隔离症。与开胸手术相比,胸腔镜创伤小、恢复快、并发症更少。

Objective To compare the clinical efficacy between thoracoscopic surgery and traditional thoracotomy in the treatment for children with congenital pulmonary sequestration(PS),and investigate the value of thoracoscopic surgery for PS.Methods The clinical data of 41 children diagnosed with congenital PS and surgically treated in our hospital from January 2015 to January 2020 were collected and retrospectively analyzed.The choice of clinical surgical methods was determined by the inclusion criteria for patients of the 2 groups respectively.According to the received surgical methods,these children were assigned into thoracotomy group(n=20,12 males and 8 females,86.07±38.96 months,ranging from 3 d to 12 years and 8 months old)and thoracoscopy group(n=21,11 males and 10 females,99.06±57.38 months,ranging from 4 months to 11 years and 2 months old).All of them were followed up for 5 months to 5 years.The operation time,intraoperative blood loss,chest drainage time,postoperative hospital stay and other surgical indicators were compared and analyzed between the 2 groups,so were the mortality,incidence of complications and recurrence.Results Both groups were successfully completed the surgery with no death or serious complications.There were no significant differences in age,weight and sites of disease between the 2 groups(P>0.05),and 1 case in the thoracoscopy group was converted to thoracotomy during operation due to severe pleural adhesion.The intraoperative blood loss,and times for postoperative mechanical ventilation,chest drainage tube indwelling,retention in coronary care unit(CCU)and hospital stay in the thoracoscopy group were statistically better than those in the thoracotomy group(P<0.05).However,the operation time in the thoracoscopy group was obviously longer than that in the thoracotomy group(P<0.05).Conclusion Both thoracoscopic surgery and thoracotomy can effectively treat congenital PS in children.Compared with thoracotomy,thoracoscopy has less trauma,faster recovery and fewer complications.