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目的对比小切口开胸与电视胸腔镜下儿童肺叶切除的短期治疗效果。方法回顾性分析2011年6月至2016年6月上海市新华医院行肺叶切除术42例患儿的临床资料,其中男24例、女18例,年龄4个月~16岁,平均年龄(7.13±5.00)岁。按手术方法的不同分为胸腔镜组(n=22)和小切口组(n=20),比较两组患儿的年龄、体质量、手术时间、术中出血量、胸腔引流时间、术后住院时间和术后并发症。结果两组患儿年龄、体质量差异无统计学意义[(8.44±4.99)岁vs.(5.68±4.69)岁,t=1.84,P=0.07;(34.18±16.52)kg vs.(25.03±18.06)kg,t=1.72,P=0.09];胸腔镜组2例(9%)因胸腔粘连中转小切口手术,其余手术均顺利完成,两组间手术时间[(151.64±74.59)min vs.(136.40±50.36 min)min,t=0.77,P=0.45]、术中出血量[(43.41±45.91)ml vs.(79.50±131.00)ml,t=–1.21,P=0.23]、胸腔引流时间[(5.00±1.79)d vs.(4.90±2.36)d,t=0.23,P=0.82)]、术后住院时间[(8.41±3.11)d vs.(8.65±2.66)d,t=–0.27,P=0.79)]差异均无统计学意义;住院期间胸腔镜组出现1例肺部感染,经抗感染治疗后痊愈,其余患者顺利恢复,无肺不张、活动性出血、支气管胸膜瘘等术后并发症发生。结论小切口开胸与电视胸腔镜下儿童肺叶切除均安全有效,短期治疗效果相近,但胸腔镜手术切口相对较小,更加美观。
Objective To compare the short-term outcomes of small-incision thoracotomy and pediatric lobectomy under video-assisted thoracoscopic surgery. Methods The clinical data of 42 cases undergoing lobectomy in Xinhua Hospital of Shanghai from June 2011 to June 2016 were retrospectively analyzed. There were 24 males and 18 females, aged from 4 months to 16 years and mean age (7.13 ± 5.00) years old. Thoracoscopic group (n = 22) and small incision group (n = 20) were divided according to the surgical methods. The age, body mass, operation time, intraoperative blood loss, chest drainage time, Hospitalization and postoperative complications. Results There was no significant difference in age and body weight between the two groups [(8.44 ± 4.99) vs. (5.68 ± 4.69) years, t = 1.84, P = 0.07; 34.18 ± 16.52 kg vs. 25.03 ± 18.06 ), t = 1.72, P = 0.09]. In the thoracoscopic group, 2 patients (9%) underwent small incision thoracic adhesions and other operations were successfully completed. The operation time [(151.64 ± 74.59) min vs. (43.41 ± 45.91) ml vs. (79.50 ± 131.00) ml, t = -1.21, P = 0.23], and the time of pleural drainage was [136.40 ± 50.36 min, t = 0.77, (5.00 ± 1.79) d vs. 4.90 ± 2.36 d, t = 0.23, P = 0.82). The postoperative hospital stay was (8.41 ± 3.11) days vs. (8.65 ± 2.66 days), t = -0.27 P = 0.79)]; There was no significant difference between the two groups (P> 0.05). One case of pulmonary infection in the thoracoscopy group during hospitalization was recovered after anti-infective therapy and the other patients recovered successfully without atelectasis, active bleeding and bronchopleural fistula Postoperative complications occurred. Conclusion Small-incision thoracotomy is safe and effective for pediatric lobectomy under VATS. Short-term treatment results are similar, but thoracoscopic surgical incision is relatively small and more beautiful.