应用悬吊腔镜技术治疗肋骨分叉畸形

Treatment of bifid ribs by gasless endoscopy using lift device

目的介绍无注气悬吊腔镜技术在治疗肋骨分叉畸形手术中的应用,探讨该手术技术的安全性和可行性。方法回顾2008年7月至2019年12月期间在首都医科大学附属北京儿童医院胸外科行无注气悬吊腔镜辅助手术治疗的单纯肋骨分叉畸形患儿,排除合并漏斗胸、鸡胸、Poland综合征等其他胸壁畸形和采取观察或支具保守治疗的病例。最终入组278例,男183例,女95例;年龄(5.7±2.5)岁。入组病例中单根叉状肋242例,多根叉状肋36例;右侧184例,左侧68例,双侧26例。总结分析叉状肋患儿的性别、年龄、畸形位置与分型、围手术期及随访等情况。结果全组患儿均顺利完成手术。肋骨分叉畸形按照发生率从高到低排序,分别为第5、第4、第3、第6。手术(64.5±16.1)min,术中出血(4.8±2.1)ml。术中、术后均未发生严重手术并发症。随访7~120个月,无复发病例。结论无注气悬吊腔镜技术在肋骨分叉畸形手术中的应用安全可行,效果良好。相较于开放手术,该手术损伤小、切口小而隐蔽,前胸无手术瘢痕。无注气悬吊腔镜辅助技术可以作为治疗肋骨分叉畸形手术的一种选择。

Objective Gasless laparoscopic surgery using lifting device was first introduced in 1993 mainly for general surgery and gynecology.Here we report its application in bifid rib treatment and explore the feasibility and safety of the surgery.Methods From July 2008 to December 2019,according to the enrollment criteria,278 patients of bifid ribs were treated at the Department of Thoracic Surgery,Beijing Children’s Hospital,Capital Medical University,including 183 males and 95 females,the mean age was(5.7±2.5)years old.There were 242 cases of single bifid rib and 36 cases of multiple bifid ribs.The bifid ribs were more common on the right side,as 184 cases had bifid ribs on right side,while only 68 cases on the left side and 26 cases on both sides.Patients’clinical data were retrospectively summarized and analyzed,including the patients’gender,age,location and type of bifid rib,perioperative outcome,and follow-up.Results All the 278 patients successfully completed the operation.The abnormality was most frequently found in the fifth rib(incidence ranking:fifth>fourth>third>sixth).The mean operation time was(64.5±16.1)min,and the mean blood loss was(4.8±2.1)ml.No serious complications occurred during the surgery.Follow-up was done for 7 to 120 months,and no recurrent patients were observed.Conclusion Gasless endoscopy with lifting device has been used as a safe and effective method to treat bifid ribs in our hospital.This surgery leads to less injury,smaller incision,and no scars on the front chest.Gasless endoscopic surgery with lifting device can be one of the options for correcting bifid ribs.