胸腔镜膈肌折叠术治疗小儿膈膨升2种不同缝线缝合打结法的比较  

Comparison of Two Different Suture Knotting Methods in Thoracoscopic Diaphragm Plication in the Treatment of Diaphragmatic Eventration in Infants

作　　者：欧作强 蒋丹华 黄高杰 李永明 黄名 曾甜[1] Ou Zuoqiang;Jiang Danhua;Huang Gaojie(Department of Neonatal Surgery,Maternal&Child Health Hospital of Guangxi Zhuang Autonomous Region,Guangxi Clinical Research Center for Pediatric Diseases,Nanning 530003,China)

机构地区：[1]广西壮族自治区妇幼保健院新生儿外科广西儿科疾病临床研究中心,南宁530003

出　　处：《中国微创外科杂志》2024年第1期34-40,共7页Chinese Journal of Minimally Invasive Surgery

基　　金：广西儿科疾病临床医学研究中心(桂科AD22035121);广西医疗卫生适宜技术开发与推广应用项目(S2020059);广西卫生健康委员会自筹经费科研课题(Z-A20230351)。

摘　　要：目的探讨改良Prolene线双头针“U”型缝合联合腔外腔内结合打结法在胸腔镜膈肌折叠术治疗小儿膈膨升中应用的可行性、安全性及手术效果。方法回顾性分析我院2010年5月~2022年5月70例膈膨升行胸腔镜膈肌折叠术的临床资料,根据缝合打结方法的不同分为改良组(改良Prolene线双头针“U”型缝合联合腔外腔内结合打结法,n=30)和常规组(腔内缝合打结法,n=40),比较2组患儿围术期指标及有无线结松开或膈膨升复发等。结果70例手术均顺利完成,无中转开放手术。改良组手术时间明显短于常规组[(35.3±7.4)min vs.(64.7±10.8)min,t=13.521,P=0.000]。2组术中出血量、留置胸腔引流管时间、术后住院时间、术前术中和术后动脉血气pH值、PO_(2)、PCO_(2)和术后术侧膈肌轻微上升等差异无统计学意义(P>0.05)。70例术后随访6~24个月,中位随访时间12个月,均无线结松开和膈膨升复发,无死亡。结论胸腔镜膈肌折叠术治疗小儿膈膨升采用改良Prolene线双头针“U”型缝合联合腔外腔内结合打结法安全可行、疗效确切,且简单易操作,具有一定腔镜手术基础的医生可快速掌握,适宜有条件的医院推广开展。Objective To discuss the feasibility,safety and surgical effect of the modified Prolene thread double-headed needle“U-shaped”suture combined with extra-and intracavity combination knotting method in thoracoscopic diaphragm plication in the treatment of diaphragmatic eventration in infants.Methods A retrospective analysis was conducted on clinical data of 70 infants who underwent thoracoscopic diaphragm plication in the treatment of diaphragmatic eventration in our hospital from May 2010 to May 2022.According to the different methods of suturing and knotting,the patients were divided into the improved group(modified Prolene thread double-headed needle“U-shaped”suture combined with extra-and intracavity combination knotting method,n=30)and the conventional group(intracavity suture knotting method,n=40).The perioperative indicators,as well as whether there was knot loosening or recurrence of diaphragmatic eventration,were compared between the two groups.Results All the 70 operations were performed safely and successfully,without conversion to open surgery.The operation time in the improved group was significantly less than that in the conventional group[(35.3±7.4)min vs.(64.7±10.8)min,t=13.521,P=0.000].There were no statistically significant differences between the two groups in terms of intraoperative bleeding volume,indwelling time of thoracic drainage tube,postoperative hospital stay,preoperative,intraoperative,and postoperative pH values,PO_(2),and PCO_(2) in arterial blood gas,and postoperative slight diaphragm elevation(P>0.05).All the 70 cases were followed up for 6-24 months postoperatively,with a median follow-up time of 12 months,having no knot loosening or recurrence of diaphragmatic eventration.No death was reported.Conclusions The modified Prolene thread double-headed needle“U-shaped”suture combined with extra-and intracavity combination knotting method in thoracoscopic diaphragm plication in the treatment of diaphragmatic eventration in infants is safe,feasible,effective,and easy to opera

关 键 词：腔内缝合打结法 胸腔镜 膈肌折叠术 小儿膈膨升 

分 类 号：R726.5[医药卫生—儿科]