CAJ | 학술논문

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2010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[(65±21)mimvs.(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)d vs.(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.
목적 대비관찰개방수술(개흉혹개복)여흉강경치료소인선천성격팽승적료효,총결흉강경치료소인선천성격팽승적경험.방법 회고성분석2007년1월지2012년9월복단대학인과의원외과수치적31례인동선천성격팽승환인적림상자료.안수술방법적불동장환인분위량조,A조위2007년1월지2010년1월수치적17례,기중우측격팽승채용개흉절첩수보격기,술후상규방치흉강인류；좌측격팽승개복수술절첩수보.B조위2010년2월지2012년9월수치적14례경흉강경수보격기,기중간단봉합격기1례,련속봉합수보13례.전6례방치흉강인류,후8례미방치인류,분석비교량조환인적수술시간、흉강인류시간、출혈량、수술후주원시간화수술후병발증.결과 량조환인년령、체중、평균격기태고륵간수기본상동；평균수술시간접근[(65±21)mimvs.(72±17)mim];A조환인평균수술후주원시간、출혈량화흉강인류시간균대우B조,분별위[(5.5±0.7)d vs.(3.8+0.4)d]；[(18±4.5)ml vs.(5.5±1.5)ml]화[(3.3±1.1)d vs.(1.8±0.5)d].B조중1례인합병환측폐격리증중전개흉,여무중전개방수술자,무수술중사망병례.A조화B조분별평균수방3.3년화1.8년,각유1례복발,균행개흉혹개복수술재수보격기.결론 여전통개방수술상비,흉강경하수술치료인동선천성격팽승구유술중시간단、출혈소,회복쾌、절구반흔소적우점.
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 Childrer'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) min],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.