胸腔镜下婴幼儿胸腹裂孔疝修补临床研究  

Therapeutic effect of video-assisted thoracoscopic repair of infantile pleuroperitoneal hiatus hernia

作　　者：刘叶[1] 王贤书[1] 王盛华[1] 谷红霞[1] 杜娟 岳芳[1] 曹红宾[1] 方江顺[1] LIU Ye;WANG Xianshu;WANG Shenghua(Department of Thoracic Surgery,Children’s Hospital of Hebei Province,Shijiazhuang,050031,China)

机构地区：[1]河北省儿童医院胸外科,石家庄市050031

出　　处：《河北医药》2021年第13期1945-1949,共5页Hebei Medical Journal

基　　金：河北省医学科学研究重点课题(编号:20190832)。

摘　　要：目的对比开放手术与全胸腔镜下婴幼儿胸腹裂孔疝修补的疗效。方法回顾性分析2010年1月至2019年1月收治的先天性胸腹裂孔疝76例,按手术方式不同分为胸腔镜组和开放手术组,各组再按病情程度分轻、中、重三组,轻度组直接手术,中、重度组患儿采用肺保护性通气策略管理,掌握合适的手术时机,40例患儿中除2例中转开胸外,其余病例均于全胸腔镜下手术;另36例患儿接受传统开放手术治疗。结果76例患儿左侧50例,右侧26例,胸腔镜组患儿中38例完成全胸腔镜手术,2例中转开胸完成手术,有疝囊者14例,无疝囊者26例,小年龄组手术耗时、呼吸机支持时间、住院时间均较其他年龄段长(P<0.05);36例开放手术组各年龄段患儿手术时间均较胸腔镜组短(P=0.000),住院时间及术中出血量均较胸腔镜组多(P=0.000;P=0.000),2组患者术后并发症差异无统计学意义(P=0.756);组内比较,重症患儿手术时间、出血量等均较轻、中症患者多(P<0.05);76例全愈出院,随访2年,良好73例,复发3例,再开胸完成手术。无死亡病例。结论全胸腔镜下手术治疗婴幼儿胸腹裂孔疝,具有术中出血少、术后恢复快、切口瘢痕小的优点,安全可行。Objective To compare the therapeutic effect of open surgery and video-assisted thoracoscopic repair of infantile pleuroperitoneal hiatus hernia.Methods 76 cases of infantile pleuroperitoneal hiatus hernia treated by open surgery and video-assisted thoracoscopic repair in the Children’s Hospital of Hebei Province from January 2010 to January 2019 were retrospectively analyzed.The patients were divided into two groups according to the surgical type,each group were divided into three groups according to the degree of disease.The mild group was operated directly.The moderate and severe group was managed with protective ventilation strategy to master the proper operation time.2 cases of the 40 cases who were underwent thoracoscopic repair were converted to thoracotomy.Finally,38 cases and 36 cases were under video-assisted thoracoscopy and open surgery throughout the operation.Results The mean age of 76 children was 6 months and 1 day,with 42 males and 34 females,50 on the left and 26 on the right.In the thoracoscopic group,38 children completed complete thoracoscopic surgery,and 2 patients were converted to thoracotomy to complete surgery,14 with hernia sac and 26 without hernia sac.The operation time,ventilator support time and hospitalization time in the younger age group were longer than those in the other age groups(P<0.05).36 cases of open surgery were performed.Compared with the thoracoscopic group,the operation time of children of all ages in the open surgery group was shorter(P=0.000),and the length of hospital stay and intraoperative blood loss were longer(P=0.000;P=0.000),and there was no statistical difference in postoperative complications between the two groups(P=0.756).Within the group,the operative time and the amount of blood loss in the severe cases were more than those in the mild and moderate cases(P<0.05).All 76 patients recovered and were discharged from hospital.Follow-up for 2 years showed that 73 cases were good and 3 cases relapsed.Thoracotomy was performed again.There were no deaths in thi

关 键 词：胸腹裂孔 先天性膈疝 胸腔镜 修补 手术 

分 类 号：R656.2[医药卫生—外科学]