开放手术与胸腔镜治疗小儿先天性膈膨升的疗效对比观察  

Comparative study of open and thoracoscopic repair for congenital diaphragmatic eventration in children

作　　者：刘江斌[1] 闫宪刚[1] 陈功[1] 董岿然[1] 郑珊[1] 肖现民[1] 

机构地区：[1]复旦大学附属儿科医院外科,上海201102

出　　处：《中华小儿外科杂志》2014年第1期39-42,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的对比观察开放手术（开胸或开腹）与胸腔镜治疗小儿先天性膈膨升的疗效，总结胸腔镜治疗小儿先天性膈膨升的经验。方法回顾性分析2007年1月至2012年9月复旦大学儿科医院外科收治的31例儿童先天性膈膨升患儿的临床资料。按手术方法的不同将患儿分为两组，A组为2007年1月至2011）年1月收治的17例，其中右侧膈膨升采用开胸折叠修补膈肌，术后常规放置胸腔引流；左侧膈膨升开腹手术折叠修补。B组为2010年2月至2012年9月收治的14例经胸腔镜修补膈肌，其中间断缝合膈肌1例，连续缝合修补13例。前6例放置胸腔引流，后8例未放置引流，分析比较两组患儿的手术时间、胸腔引流时间、出血量、手术后住院时间和手术后并发症。结果两组患儿年龄、体重、平均膈肌抬高肋间数基本相同；平均手术时间接近E（65±21）mim vs．（72±17）mim]；A组患儿平均手术后住院时间、出血量和胸腔引流时间均大于B组，分别为[（5．5±0．7）dVS．（3．8±0．4）d]；[（18±4．5）ml vs．（5．5±1．5）ml]和[（3．3±1．1）d vs．（1．8±0．5）d]。B组中1例因合并患侧肺隔离症中转开胸，余无中转开放手术者，无手术中死亡病例。A组和B组分别平均随访3．3年和1．8年，各有1例复发，均行开胸或开腹手术再修补膈肌。结论与传统开放手术相比，胸腔镜下手术治疗儿童先天性膈膨升具有术中时间短、出血少，恢复快、切口瘢痕小的优点。Objective To compare the results of open and thoracoscopic repair for congenital diaphragmatic eventration in children and review the experience of thoracoscopic repair. Methods From January 2007 to September 2012, 31 children with congenital diaphragmatic eventration were repaired by open or thoracoscopic operation in Children＇s Hospital of Fudan university. These patients were divided into 2 groups. In group A, from January 2007 to January 2010,17 patients were operated by open procedure. Thoracotomy was done for right-sided enventration and trans-abdominal repair for left-sided. In group B, from February 2010 to September 2012, 14 patients were treated by thoracoscopy. Operative time, blood loss, drainage, postoperative hospital stay and complications were analyzed. Results Age, body weight, symptoms, and signs were not different between the 2 groups. The operative time in group A and group B was nearly the same [（65 ± 21 vs 72 ± 17） mini,but the postoperative stay in hospital was longer, volume of bleeding was higher, and the drainage duration was longer in group A than those in group B [（5.5 ± 0. 7 vs. 3.8 ± 0. 4）d; （18 ± 4. 5 vs. 5.5 ± 1.5）ml and （3. 3 ± 1. 1 vs. 1.8 ± 0. 5）d,respectively]. In group B, thoracoscopy was converted to thoracotomy in 1 case. There was no mortality and the patients were followed up for 3.3 and 1.8 years on average in group A and group B, respectively. Only 1 recurrence was found in either group. Conclusions Thoracoscopic repair for diaphragmatic eventration is a safe and effective procedure and this minimally invasive procedure could take the place of open surgery.

关 键 词：膈膨出 胸腔镜检查 对比研究 

分 类 号：R726.5[医药卫生—儿科]