腔镜下腋、颈部入路胸锁乳突肌松解术矫正先天性肌性斜颈  

Endoscopic release of torticoilis

作　　者：汤绍涛[1] 毛永忠[1] 童强松[1] 王勇[1] 杨瑛[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院小儿外科,武汉430022

出　　处：《中华小儿外科杂志》2009年第6期353-356,共4页Chinese Journal of Pediatric Surgery

基　　金：国家十一五科技支撑项目子项目2006BA105A06

摘　　要：目的介绍腔镜下腋、颈部入路胸锁乳突肌松解术在先天肌性斜颈中的应用并探讨疗效。方法34例患儿，年龄6个月～14岁。患侧腋窝前缘顶端置入5mm trocar，手持镜头在胸锁乳突肌胸骨头与锁骨头浅面建立颈前皮下间隙，充入CO2气体加压至6mmHg。分别在胸锁乳头肌下端两侧做2个1．5～2mm切口，直接放入电刀和微型操作钳。分次电凝横断胸锁乳突肌胸骨头与锁骨头的肌纤维束及周围紧张的纤维组织，清晰显露颈血管鞘及肩胛舌骨肌肌腹。采用Lee等的评分进行临床评估。结果34例均在腔镜下完成手术。平均手术时间50min（40-120min）。未损伤周围大血管和神经。术中1例患儿出血，采用吸收夹夹闭止血。术后随访6个月～3年，优88．2％，良8．8％，可3．0％，优良率97％。术后1个月所有患儿颈前伤口瘢痕肉眼显现不明显，颈部皮肤弹性好。结论腔镜下腋、颈部胸锁乳突肌切断松解术治疗先天性肌性斜颈手术视野广，操作简单，疗效确切，术中术后并发症少，具有极佳的美学效果。Objective A transaxillary and transeervical endoscopy technique was developed for the release of the sternocleidomastoid muscle in congenital muscular torticollis. The efficacy of the operation was evaluated. Methods A total of 34 children with congenital torticollis were treated. The age ranged from 6 month to 14 years. A 5 mm trocar was inserted in the anterior axillary fold. A subcuta neous tunnel perpendicular to the axis of the sternocleidomastoid was made,initially under direct vision and then endoscopically using a 5 mm endoscope. A subcutaneous space was established with CO2 inflation at the pressure of 6 mm Hg. Another two 1.5-2 mm incisions were made besides sternocleidomastoid for the introduction of mini forceps and electric knife, respectively. The sternoeleidomastoid muscle and scalene were dissected out and divided with electrocautery. Lee＇s evaluation was carried out post-operatively. Results The operation was successfully completed under endoscope in all children. The mean operation time was 50 min （ range： 40- 120 min）. No injury of major nerve was encoun tered. Haemorrage in one child required re-operation. Follow-up for 6 months to 3 years showed satis factory cosmetic appearance and no recurrence. The results were classified as excellent in 88. 2%,good in 8. 8%,and fair in 3.0%. The neck scars were not visible one month after surgery. Conclusions Transaxillary and transcervicai endoscopic release of congenital torticollis is a safe and relatively quick procedure. It provides good access and good cosmetic outcomes. It avoids injury to neurovascular structures.

关 键 词：斜颈 腹腔镜 矫正 先天性肌性斜颈 下腋 颈部 

分 类 号：R686[医药卫生—骨科学]