胸膜外入路与胸腔镜手术治疗先天性食管闭锁的疗效比较  

Extrapleural approach versus thoracoscopic surgery approach in treatment of congenital esophageal atresia

作　　者：兰照平 高琪 潘永康[2] LAN Zhao-ping;GAO Qi;PAN Yong-kang(Xi'an Medical University,Xi'an,Shaanxi 710003,China;不详)

机构地区：[1]西安医学院,陕西西安710003 [2]西安市儿童医院新生儿外科,陕西西安710003

出　　处：《中国临床研究》2022年第4期517-521,共5页Chinese Journal of Clinical Research

摘　　要：目的探讨经胸膜外入路与胸腔镜两种手术方式治疗先天性食管闭锁的疗效差异。方法收集西安市儿童医院2013年2月至2019年6月收治的99例确诊为Ⅲ型先天性食管闭锁并行手术治疗患儿的临床资料,均行一期食管气管瘘结扎、食管端端吻合术,根据手术方式的不同分为胸膜外入路组(开胸)69例和胸腔镜组(微创)30例,比较不同手术方式患儿手术时间、呼吸机使用时间、住院时间、术后相关并发症之间是否存在差异。结果99例患儿住院期间无死亡病例。胸膜外入路组、胸腔镜组患儿手术时间中位值分别为2.40 h、3.70 h,手术后呼吸机使用时间中位值分别为3.00 d、6.00 d,两组比较差异均有统计学意义(Z=6.320、3.558,P<0.01);手术后住院时间中位值分别为19.00 d、22.80 d,两组比较差异无统计学意义(Z=1.640,P=0.101)。胸膜外入路组吻合口瘘、吻合口狭窄、气胸、食管气管瘘复发、皮下积气的发生率均低于胸腔镜组,差异均有统计学意义(P<0.01,P<0.05)。结论胸腔镜治疗先天性食管闭锁、气管食管瘘,在缩短手术时间、减少术后并发症、减少经济支出方面并不占优势,这可能与缺乏一定的手术经验有关;而在减小手术创伤、手术切口,减少胸壁畸形相关并发症方面有一定优势。在胸腔镜手术能成熟开展之前,更推荐开胸手术。Objective To compare the curative effect between extrapleural approach and thoracoscopic surgery in the treatment of congenital esophageal atresia(EA).Methods The clinical data of 99 children with type Ⅲ congenital EA treated with surgery in Xi'an Children's Hospital from February 2013 to June 2019 were collected.Out of all patients receiving one-stage ligation of esophagotracheal fistula and end-to-end anastomosis,there were 69 cases in extrapleural approach group(thoracotomy)and 30 cases in thoracoscopy group(minimally invasive).The operation time,ventilator supporting time,hospital stay and postoperative complications were compared between two groups.Results There was no death during hospitalization.The median operation time was 2.40 h in extrapleural approach group and 3.70 h in thoracoscopy group.The median time of ventilator service after operation was 3.00 d in extrapleural approach group and 6.00 d in thoracoscopy group.There were significant differences in them between two groups(Z=6.320,3.558,P<0.01).There was no significant difference in the median length of hospital stay after operation between extrapleural approach group and thoracoscopy group(19.00 d vs 22.80 d,Z=1.640,P=0.101).The incidences of anastomotic leakage,anastomotic stenosis,pneumothorax,recurrence of esophagotracheal fistula and subcutaneous emphysema in extrapleural approach group were significantly lower than those in thoracoscopy group(P<0.01,P<0.05).Conclusion Thoracoscopic treatment of congenital esophageal atresia and tracheoesophageal fistula has no advantage in shortening operation time and reducing postoperative complications and economic expenditure,which may be related to the lack of certain surgical experience,however,it has certain advantages in reducing surgical trauma,surgical incisions and complication related to chest wall deformity.Thoracotomy is more recommended before thoracoscopic surgery can be carried out maturely.

关 键 词：食管闭锁 气管食管瘘 胸腔镜手术 胸膜外入路手术 

分 类 号：R726.1[医药卫生—儿科]