胸腔镜和传统开放性手术治疗婴幼儿先天性膈膨升的回顾性队列研究

Thoracoscopic surgery versus traditional open surgery for infants with congenital diaphragmatic eventration: A retrospective cohort study

目的对比分析胸腔镜和传统开放性手术在婴幼儿先天性膈膨升中的疗效,总结胸腔镜手术治疗婴幼儿先天性膈膨升的经验。方法回顾性分析2010年1月至2019年1月在重庆医科大学附属儿童医院心胸外科进行手术治疗的105例先天性膈膨升患儿的临床资料。按手术方式将患儿分为开放组和胸腔镜组,胸腔镜组41例,其中男30例、女11例,年龄1 d~3岁(13.42±11.08)个月;开放组64例,其中男44例、女20例,年龄15.0 d~1.6岁(8.21±9.33)个月。观察两组患儿手术时间、术中出血量、术后机械通气时间、住院时间等手术指标以及死亡率、复发率及并发症发生率等情况。结果胸腔镜组手术时间、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放组患儿,差异有统计学意义(P<0.05);两组间术后膈肌下降肋间、术后进食时间、术后胸腔积液发生率差异无统计学意义(P>0.05);胸腔镜组患儿术后并发症发生率(19.51%)低于开放组(23.44%),但差异无统计学意义(P>0.05),两组死亡率及复发率差异也无统计学意义(P>0.05)。结论胸腔镜膈肌折叠术与传统开放性手术均能有效治疗先天性膈膨升,但胸腔镜膈肌折叠术相比传统开放性手术而言,具有手术时间短、创伤小、恢复快、并发症少等优势,应作为先天性膈膨升患儿的首选治疗方式。

Objective To compare and analyze the treatment effect of thoracoscopic surgery and traditional open surgery on infants with congenital diaphragmatic eventration,and summarize the experience of thoracoscopic surgery in infants with congenital diaphragmatic eventration.Methods We retrospectively analyzed the clinical data of 105 children with congenital diaphragmatic eventration who received operation in the Department of Cardiothoracic Surgery of Children’s Hospital of Chongqing Medical University from January 2010 to January 2019.The patients were divided into an open group and a thoracoscopic group according to the operation methods.There were 41 patients in the thoracoscopic group,including 30 males and 11 females,with an average of 13.42±11.08 months(range:1 d to3 years).There were 64 patients in the open group,including 44 males and 20 females,with an average age of 8.21±9.33 months(range:15.0 d to 1.6 years).The operation time,intraoperative bleeding volume,postoperative mechanical ventilation time,hospital stay and other operation indexes as well as the mortality,recurrence rate and complication rate of the two groups were observed.Results The operation indexes such as operation time,intraoperative bleeding volume,postoperative mechanical ventilation time,thoracic drainage time,CCU stay and hospital stay of the thoracoscopic group were better than those in the open group(P<0.05).There was no statistical difference between two groups in postoperative diaphgram muscles descent,postoperative feeding time or patients needing thoracic drainage(P>0.05).The incidence of postoperative complications in the thoracoscopic group(19.51%)was lower than that in the open group(23.44%,P>0.05),and the difference in mortality and recurrence rate between the two groups was not statistically significant(P>0.05).Conclusion Both thoracoscopic diaphragmatic plication and traditional open surgery can effectively treat congenital diaphragmatic eventration,but compared with traditional open surgery,thoracoscopic diaphragmatic plication has the advantages of shorter operation time,less trauma,more rapid recovery and fewer complications,so it should be the first choice for children with congenital diaphragmatic eventration.