全胸腔镜下动脉导管结扎术治疗小儿动脉导管未闭32例  

Total thoracoscopic ligation of patent ductusarteriosus in children:a report of 32 cases

作　　者：陈润森 莫绪明[1] 戚继荣[1] 彭卫[1] 武开宏[1] 孙剑[1] 郁迪[1] 张玉喜[1] 王智琪[1] 杨玉忠[1] 庄著伦[1] 笪敏[1] 扈元利 钱波[1] 陈涌[1] Chen Runsen;Mo Xuming;Qi Jirong;Peng Wei;Wu Kaihong;Sun Jian;Yu Di;Zhang Yuxi;Wang Zhiqi;Yang Yuzhong;Zhuang Zhulun;Da Min;Hu Yuanli;Qian Bo;Chen Yong(Department of Cardiothoracic Surgery,Children's Hospital,Nanjing Medical University,Nanjing 210129,China)

机构地区：[1]南京医科大学附属儿童医院心胸外科,南京210129

出　　处：《临床小儿外科杂志》2023年第5期431-435,共5页Journal of Clinical Pediatric Surgery

基　　金：江苏省自然科学基金(BK20210032);江苏省科技计划(资金)重大科技示范项目(BE2023710006)

摘　　要：目的探讨全胸腔镜下动脉导管结扎术的临床疗效及安全性。方法回顾性分析2017年1月至2023年4月南京医科大学附属儿童医院心胸外科经全胸腔镜手术治疗的32例动脉导管未闭(patent ductusarteriosus,PDA)患儿临床资料。其中男15例,女17例,中位年龄2岁4个月(6个月至13岁2个月),中位体重18.5 kg(9.1~42.3 kg)。收集手术时间,术中出血量,术后呼吸机辅助时间、胸腔引流量、胸腔引流管放置时间以及住院时间。观察术后残余分流、导管再通、喉返神经损伤、乳糜胸、气胸、胸腔积液等并发症的发生情况。结果32例均在全胸腔镜下顺利完成手术,无一例中转开胸手术。平均手术时间71.2 min(45~95 min),术中平均出血量5.1 mL(5~26 mL),术后平均呼吸机辅助通气时间2.8 h(2~4 h),平均胸腔引流量29.6 mL(19~60 mL),留置胸腔引流管平均时间1.8 d(1~4 d),平均住院时间4.9 d(4~7 d)。术后2例(2/32,6.3%)出现喉返神经损伤症状,门诊随访1~6个月后症状较前改善。所有患儿随访1个月至3年,无一例出现胸腔积液及导管再通。结论全胸腔镜下PDA结扎术具有切口美观、疼痛轻、并发症少、恢复快、住院时间短等优点,疗效确切,安全性高,值得临床推广。Objective To evaluate the efficacy and safety of thoracoscop in the treatment of patent ductus arteriosus(PDA)in children.Methods From January 2017 to April 2023,clinical data were retrospectively reviewed for 32 PDA children undergoing thoracoscopy.There were 15 boys and 17 girls with a median age of 52(6-158)month and a median weight of 18.5(9.1-42.3)kg.Operative duration,volume of intraoperative blood loss,volume of postoperative thoracic drainage,drainage tube removal time and postoperative hospital stay were recorded.Regular postoperative follow-ups were performed.And the occurrences of postoperative complications related to residual shunt,duct recanalization,recurrent nerve injury,chylothorax,pneumothorax and pleural effusion were recorded.Results All procedures were completed via thoracoscopy.There was no intraoperative conversion into thoracotomy.The average operative duration was 71.2(45-95)min,volume of blood loss 5.1(5-26)mL,duration of postoperative mechanical ventilation 2.8(2-4)min,volume of postoperative thoracic drainage 29.6(19-60)mL,drainage tube removal time 1.8(1-4)d and average postoperative hospital stay 4.9(4-7)days.Two case of recurrent laryngeal nerve injury improved after 1-6 months.No other complications occurred during a follow-up period of(1-36)months.Conclusion Thoracoscopy for pediatric PDA is worth further popularized since it both safe and reliable with minimal incision,lesser pain,fewer complications,faster recovery and shorter hospital stay.

关 键 词：心脏病 先天畸形 最小侵入性外科手术 外科手术 儿童 

分 类 号：R726.5[医药卫生—儿科]