摘要
目的探讨疝气针辅助胸腔镜下膈肌折叠术治疗先天性膈膨升的疗效。方法选取2015年1月至2024年7月在解放军总医院第七医学中心诊断为先天性膈膨升并行胸腔镜下膈肌折叠术的患儿40例,按照随机数字表法将其分为研究组和对照组,每组各20例。研究组患儿采用疝气针辅助胸腔镜下膈肌折叠术,对照组患儿采用传统胸腔镜下膈肌折叠术。比较2组患儿的术中出血量、切口长度、手术时间、术后机械通气时间、拔出胸腔引流管时间、术后进食时间、住院时间、术后复发率和生存率。统计学方法采用独立样本t检验、χ^(2)检验。结果研究组与对照组患儿的性别、胎龄、出生体质量以及发病部位比较,差异均无统计学意义(P值均>0.05)。研究组的术中出血量少于对照组[(2.12±0.41)ml与(3.02±0.56)ml,t=-5.012,P=0.002];切口长度[(1.59±0.39)cm与(2.77±0.42)cm,t=-6.474,P=0.015]、手术时间[(79.91±10.15)min与(93.22±7.84)min,t=-3.279,P=0.023]、术后机械通气时间[(1.32±0.32)d与(1.64±0.67)d,t=-5.186,P=0.044]、术后进食时间[(1.61±0.29)d与(1.95±0.27)d,t=-2.762,P=0.032]、拔出胸腔引流管时间[(3.08±0.50)d与(3.21±0.44)d,t=-3.615,P=0.019]、住院时间[(12.80±0.33)d与(16.12±0.47)d,t=-3.328,P=0.044]均短于对照组,差异均有统计学意义。术后,研究组20例均治愈出院,随访均未见复发,但1例出院后随访1个月,因发生败血症而死亡;对照组20例均治愈出院,随访中术后4个月复发2例。两组的复发率比较,差异无统计学意义(P>0.05)。结论疝气针辅助胸腔镜下膈肌折叠术治疗先天性膈膨升手术创伤小,可减少术中出血量,缩短手术时间及住院时间,且安全、有效,达到了手术预期的优势,值得推广。
Objective To explore the efficacy of hernia needle-assisted thoracoscopic diaphragmatic plication in the treatment of congenital diaphragmatic eventration.Method A total of 40 children diagnosed with diaphragmatic eventration and undergoing diaphragmatic plication at the Seventh Medical Center of Chinese PLA General Hospital from January 2015 to July 2024 were selected as study subjects.They were randomly divided into the study group and the control group according to the random number table method,with 20 cases in each group.The study group received hernia needle-assisted thoracoscopic diaphragmatic plication,while the control group underwent traditional thoracoscopic diaphragmatic plication.The following parameters were compared between the two groups:intraoperative blood loss,incision length,operative time,postoperative mechanical ventilation duration,time for removing the thoracic drainage tube,postoperative feeding time,hospital stay,postoperative recurrence rate,and survival rate.Statistical analysis was performed by independent samples t-test,χ^(2) test.Result There were no statistically significant differences in gender,gestational age,birth weight,and lesion site between the infants in the study group and the control group(all P>0.05).The intraoperative blood loss in the study group was less than that in the control group[(2.12±0.41)ml vs(3.02±0.56)ml,t=-5.012,P=0.002].The incision length[(1.59±0.39)cm vs(2.77±0.42)cm,t=-6.474,P=0.015],operation time[(79.91±10.15)min vs(93.22±7.84)min,t=-3.279,P=0.023],postoperative mechanical ventilation time[(1.32±0.32)d vs(1.64±0.67)d,t=-5.186,P=0.044],postoperative feeding time[(1.61±0.29)d vs(1.95±0.27)d,t=-2.762,P=0.032],time for removing the thoracic drainage tube[(3.08±0.50)d vs(3.21±0.44)d,t=-3.615,P=0.019],and hospital stay[(12.80±0.33)d vs(16.12±0.47)d,t=-3.328,P=0.044]in the study group were all shorter than those in the control group,with statistically significant differences.After surgery,all 20 cases in the study group were cured and discharged,and no recurrence was found during follow-up.However,1 case died of sepsis 1 month after discharge during follow-up.All 20 cases in the control group were cured and discharged,and 2 cases recurred 4 months after surgery during follow-up.There was no statistically significant difference in the recurrence rate between the two groups(P>0.05).Conclusion Hernia needle-assisted thoracoscopic diaphragmatic plication for treating congenital diaphragmatic eventration demonstrates minimal surgical trauma,reduces blood loss,shortens both operative time and hospital stay,and proves to be safe and effective.This technique achieves the anticipated surgical advantages and is worthy of clinical promotion.
作者
李广
张艳平
刘钢
田静
曹剑英
谢华伟
段炼
徐翠
张珊
Li Guang;Zhang Yanping;Liu Gang;Tian Jing;Cao Jianying;Xie Huawei;Duan Lian;Xu Cui;Zhang Shan(Beijing Key Laboratory of Pediatric Organ Failure,National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology,Institute of Pediatrics,the Seventh Medical Center of Chinese PLA General Hospital,Faculty of Pediatrics,Chinese PLA General Hospital,Beijing 100700,China)
出处
《发育医学电子杂志》
2025年第4期276-281,共6页
Journal of Developmental Medicine (Electronic Version)
基金
军队计生专项科研课题(21JSZ18)。
关键词
先天性膈膨升
胸腔镜膈肌折叠术
疝气针
婴幼儿
Congenital diaphragmatic eventration
Thoracoscopic diaphragm plication
Hernia needle
Infant
