3D腹腔镜与2D腹腔镜在儿童食管裂孔疝修补及胃底折叠术中的应用对比  

Comparative analysis of three-dimensional versus two-dimensional laparoscopy for pediatric hiatal hernia

作　　者：张雁冰[1] 张甜[1] 高红强[1] 刘朝阳[1] 尹强[1] Zhang Yanbing;Zhang Tian;Gao Hongqiang;Liu Chaoyang;Yin Qiang(Department I of General Surgery,Hunan Children's Hospital,Changsha 41008,China)

机构地区：[1]湖南省儿童医院普外一科,湖南省长沙市410007

出　　处：《临床小儿外科杂志》2020年第9期847-850,共4页Journal of Clinical Pediatric Surgery

基　　金：湖南省出生缺陷协同防治科技重大专项(编号:2019SK1010)。

摘　　要：目的对3D腹腔镜与2D腹腔镜在儿童食管裂孔疝修补及胃底折叠术中的应用效果进行对比。方法以湖南省儿童医院普外一科2016年1月至2019年6月收治并行腹腔镜下食管裂孔疝修补术和(或)胃底折叠术的38例患儿为研究对象,按照术中使用腔镜种类的不同分为3D组(17例)和2D组(21例)。记录两组手术总时间、术中出血量、术后随访情况(包括呕吐、吞咽障碍、气胸、腹部感染和纵隔感染等在内的术后并发症)。术后12个月通过门诊随访,掌握病人相关并发症与复发状况。结果38例均顺利完成手术并痊愈出院,围术期无一例发生严重并发症;3D组总手术时间较2D组显著缩短[(82.4±17.7)min vs.(105.1±20.4)min,P=0.031],术中平均出血量更少[(11.6±8.2)mL vs.(18.2±6.5)mL,P=0.043];两组术后平均住院时间及术后并发症发生率差异无统计学意义(P>0.05)。结论3D腹腔镜下为儿童施行食管裂孔疝修补和胃底折叠术是安全的,与2D腹腔镜相比,操作更清晰的同时能有效缩短手术时间,减少术中出血量。Objective To compare the efficacies of three-dimensional(3D)versus two-dimensional(2D)laparoscopy for children with esophageal hiatal hernia and fundoplication.Methods A total of 38 children undergoing laparoscopic esophageal hiatal hernia repair and/or fundoplication were selected from January 2016 to June 2019.Based upon different types of endoscopes,they were divided into 3D group(n=17)and 2D group(n=21).Total operative duration,intraoperative blood loss and postoperative follow-ups(including postoperative complications of vomiting,dysphagia,pneumothorax,abdominal infection and mediastinal infection)were recorded.During a follow-up period of 12 months,postoperative complications and recurrent status were analyzed.Results All operations were successfully performed and discharged without serious perioperative complications.Total operative duration of 3D group was significantly shorter than that of 2D group[(82.4±17.7)vs.(105.1±20.4)min,P=0.031]and average intraoperative blood loss was less[(11.6±8.2)vs.(18.2±6.5)mL,P=0.043].And average postoperative hospital stay or postoperative complication rate showed no significant difference(P>0.05).Conclusion Esophageal hiatal hernia repair and fundoplication may be safely performed for children under 3D laparoscopy.As compared with 2D laparoscopy,3D laparoscopy offers a more distinct operative field and it may effectively shorten operative duration and reduce the volume of intraoperative bleeding.

关 键 词：疝 食管裂孔/外科学 腹腔镜检查 胃底折叠术 儿童 

分 类 号：R729[医药卫生—儿科] R655.4[医药卫生—临床医学]