胸腔镜手术与开胸手术治疗先天性食管闭锁伴气管食管瘘的疗效对比

Outcomes of thoracoscopy versus thoracotomy for oesophageal atresia with tracheoesophageal fistula repair

目的对比胸腔镜手术和开胸手术治疗先天性食管闭锁伴气管食管瘘的临床疗效。方法选取安徽省儿童医院2011年3月—2019年2月间行手术治疗的101例先天性食管闭锁伴气管食管瘘患儿,按手术方式分为胸腔镜组(50例)和开胸组(51例),分析2组患儿术前资料、围手术期相关指标及术后恢复情况。同时依据学习曲线将胸腔镜组患儿分为前期、后期(各25例),并对上述指标进行比较。结果(1)2组患儿术前临床资料比较差异无统计学意义(均P>0.05)。(2)围手术期指标:胸腔镜组平均手术时间[(191.42±48.56)min]长于开胸组[(129.02±25.08)min],差异有统计学意义(t=8.163,P<0.001);胸腔镜组术后初次经口喂养时间[(11.98±2.92)d]短于开胸组[(16.88±4.33)d],差异有统计学意义(t=-2.364,P=0.020)。(3)2组术后吻合口漏、吻合口狭窄发生率及气管食管瘘管复发率比较差异无统计学意义(均P>0.05)。(4)胸腔镜组后期手术时间、术后带机时间均较前期缩短,差异均有统计学意义(均P<0.05),术后吻合口漏发生率也明显下降,但差异无统计学意义(P>0.05)。结论胸腔镜手术治疗先天性食管闭锁与开胸手术效果相当,且随着手术技巧的不断改进和完善,临床疗效更为确切。

Objective To compare the clinical efficacy of thoracoscopic surgery versus thoracotomy for congenital oesophageal atresia with tracheoesophageal fistula.Methods A retrospective analysis was conducted on 101 cases of congenital oesophageal atresia treated by surgery in our hospital from March 2011 to February 2019,which were divided into the thoracoscopic surgery group(50 cases)and open thoracotomy group(51 cases)according to the surgical approaches.The preoperative data,perioperative indicators and postoperative recovery of both groups were compared.At the same time,according to the learning curve,the cases in the thoracoscopic surgery group were divided into early stage and late stage(25 cases each),and the changes of various indicators at different periods and the occurrence of postoperative complications were compared.Results(1)No significant difference was observed in the preoperative clinical data in both groups(all P>0.05).(2)Comparison of perioperative conditions in both groups showed that the mean operative time of the thoracoscopic surgery group[(191.42±48.56)min]was slightly longer than that of the open thoracotomy group[(129.02±25.08)min],and the difference was statistically significant(t=8.163,P<0.001),the time of initial oral feeding was(11.98±2.92)days versus(16.88±4.33)days,and the difference was statistically significant(t=-2.364,P=0.020).(3)Comparison of postoperative complications in both groups showed no significant differences in the incidence of anastomotic leakage,anastomotic stenosis and recurrence rate of tracheoesophageal fistula(all P>0.05).(4)Comparison of the two stages in the thoracoscopic surgery group showed that the operative time and postoperative ventilation time of the late stage were significantly shorter than those of the early stage,and the differences were statistically significant(all P<0.05).In addition,the incidence of postoperative anastomotic leakage was also decreased significantly,but the difference was not statistically significant(P>0.05).Conclusion The effect of thoracoscopic surgery on congenital oesophageal atresia combined with tracheal oesophageal fistula was similar to that of thoracotomy.With the continuous improvement of surgical techniques,the clinical effect may be enhanced.