胸腔镜和开放胸膜外两种手术方式治疗新生儿Ⅲ型食管闭锁的比较

Comparative study of thoracoscopic and open extrapleural surgery in the treatment of neonatal type Ⅲ esophageal atresia

目的探讨经胸腔镜及开放胸膜外两种手术方式治疗新生儿先天性Ⅲ型食管闭锁的治疗效果,比较两种手术方式的优缺点,为临床治疗提供参考。方法回顾分析142例先天性Ⅲ型食管闭锁患儿的临床资料,根据手术方式的不同分成胸腔镜组(n=76例)和胸膜外组(n=66例),通过对比两组患儿围术期多项观察指标及术后并发症发生率等数据,比较两组的疗效情况。结果胸腔镜组患儿的手术及麻醉时间长于胸膜外组,但术中出血量少于胸膜外组,对比组之间的差异有统计学意义(P<0.001)。两组的术后进食时间、术后呼吸机使用时间、术后引流管拔除时间、术后住院时间、术中术后动脉血气中pH值、PO_(2)、PCO_(2)及术后并发症发生率的比较差异无统计学意义(P>0.05)。结论与开放胸膜外手术方式相比,虽然胸腔镜矫治Ⅲ型食管闭锁麻醉及手术时间较长,但术中出血量较少,两者其他术中术后多项观察指标及术后并发症发生率并无明显差别,胸腔镜手术疗效好、安全、微创,手术视野有放大效应,操作更精准,适宜有条件的医院推广开展。

Objective To investigate the therapeutic effects of thoracoscopic and open extrapleural surgery in the treatment of neonatal congenital TypeⅢesophageal atresia,and to compare the advantages and disadvantages of the two surgical methods,so as to provide reference for clinical treatment.Methods The clinical data of 142 patients with congenital TypeⅢesophageal atresia were retrospectively analyzed.According to different surgical methods,they were divided into thoracoscopic group(n=76)and extrapleural group(n=66).The curative effects of the two groups were compared by comparing the incidence of multiple observation indicators during the perioperative period and postoperative complications between the two groups.Results The operation and anesthesia time of patients in thoracoscopy group was significantly longer than that in extrapleural group,but the amount of intraoperative bleeding was significantly less than that in extrapleural group(P<0.001).There was no significant difference in postoperative eating time,postoperative ventilator use time,postoperative drainage tube extraction time,postoperative hospital stay,preoperative and postoperative arterial blood gas pH,PO_(2),PCO_(2) or postoperative complication rate between the two groups(P>0.05).Conclusion Compared with open extrapleural surgery,thoracoscopic surgery for TypeⅢesophageal atresia takes longer anesthesia and operation time,but the amount of intraoperative bleeding is less.There is no significant difference in other intraoperative and postoperative observation indexes or the incidence of postoperative complications between the two groups.Thoracoscopic surgery is effective,safe and minimally invasive,with magnifying effect on the surgical field and more accurate operation.It is suitable for conditional hospital promotion.