CAJ | 학술논문

目的：比较胸腔镜与开放手术治疗小儿先天性膈膨升的效果。方法2008年1月～2010年2月我院收治35例先天性膈膨升，年龄3个月～3．5岁，2009年1月前收治的17例行开放手术（开放组），右侧膈膨升采用开胸折叠修补膈肌，左侧膈膨升采用开腹手术修补；2009年1月以后的18例行胸腔镜修补膈肌（胸腔镜组）。比较2组手术时间、术中出血量、术中输血例数、放置胸腔引流例数、胸腔引流时间、术后膈肌下降情况、术后住院时间、复发率。结果与开放组比较，腹腔镜组手术时间长[（75．3±5．0）min vs．（64．2±5．1）min，t＝6．501，P＝0．000]，但术中出血少[（5．6±0．4）ml vs．（18．5±1．2）ml，t＝－43．172，P＝0．000]，放置胸腔引流比例少[27．8％（5／18） vs．100．0％（17／17），P＝0．000]，胸腔引流时间短[（1．9±0．1）d （n＝5） vs．（3．5±0．4） d，t＝－8．723，P＝0．000]，术后住院时间短[（3．7±0．4） d vs．（5．6±0．5） d，t＝－12．450，P＝0．000]。2组术中输血例数、术后膈肌下降程度及复发率差异无显著性。结论胸腔镜治疗小儿先天性膈膨升与传统开放手术比较具有出血少、恢复快等优点。
목적：비교흉강경여개방수술치료소인선천성격팽승적효과。방법2008년1월～2010년2월아원수치35례선천성격팽승，년령3개월～3．5세，2009년1월전수치적17례행개방수술（개방조），우측격팽승채용개흉절첩수보격기，좌측격팽승채용개복수술수보；2009년1월이후적18례행흉강경수보격기（흉강경조）。비교2조수술시간、술중출혈량、술중수혈례수、방치흉강인류례수、흉강인류시간、술후격기하강정황、술후주원시간、복발솔。결과여개방조비교，복강경조수술시간장[（75．3±5．0）min vs．（64．2±5．1）min，t＝6．501，P＝0．000]，단술중출혈소[（5．6±0．4）ml vs．（18．5±1．2）ml，t＝－43．172，P＝0．000]，방치흉강인류비례소[27．8％（5／18） vs．100．0％（17／17），P＝0．000]，흉강인류시간단[（1．9±0．1）d （n＝5） vs．（3．5±0．4） d，t＝－8．723，P＝0．000]，술후주원시간단[（3．7±0．4） d vs．（5．6±0．5） d，t＝－12．450，P＝0．000]。2조술중수혈례수、술후격기하강정도급복발솔차이무현저성。결론흉강경치료소인선천성격팽승여전통개방수술비교구유출혈소、회복쾌등우점。
Objective To compare clinical effects between thoracoscopic and open surgery for congenital diaphragmatic eventration in children. Methods Out of 35 children aged from 3 months to 3.5 years old with congenital diaphragmatic eventration , 17 cases ( open group ) received open surgery between January 2008 and January 2009 and 18 cases ( thoracoscopic group ) received thoracoscopic surgery between January 2009 and January 2010.In the open group, thoracotomy for diaphragmatic repair was applied to those with right diaphragmatic eventration while laparotomy was used in those with left diaphragmatic eventration .In the thoracoscopic group, minimally invasive surgery under thoracoscope was performed .The operation time, blood loss, number of intraoperative transfusion, cases needing chest drainage , duration of drainage , diaphgram muscles descent after operation , length of hospital stay , and incidence of recurrence were compared between the two groups . Results As compared with the open group , the thoracoscopic group received longer operation time [(75.3 ±5.0) min vs.(64.2 ±5.1) min, t=6.501, P=0.000], less blood loss [(5.6 ± 0.4) ml vs.(18.5 ±1.2) ml, t =-43.172, P=0.000], lower proportion of chest drainage [27.8% (5/18) vs.100.0%(17/17), P=0.000], shorter duration of drainage [(1.9 ±0.1) d vs.(3.5 ±0.4) d, t=-8.723, P=0.000], and shorter length of stay [(3.7 ±0.4) d vs.(5.6 ±0.5) d, t=-12.450, P=0.000].No significant differences were recorded between the two groups in number of intraoperative transfusion , diaphgram muscles descent after operation , and incidence of recurrence . Conclusion Thoracoscopic surgery has characteristics of less intraoperative blood loss and rapid postoperative recovery in the treatment of congenital diaphragmatic eventration in children .