单术者双孔法在电视辅助胸腔镜手术治疗儿童叶外型肺隔离症中的早期临床应用

doi:10.6040/j.issn.1671-7554.0.2023.0995

摘要/Abstract

摘要： 目的总结单术者双孔法在电视辅助胸腔镜手术治疗儿童叶外型肺隔离症中的操作流程,评价此术式临床推广应用的可行性及安全性。方法回顾性收集 2020年1月至2023年8月由山东大学附属儿童医院胸外肿瘤外科同一术者完成手术的45例膈肌上型叶外型肺隔离症患者的临床资料。根据手术方式不同分为双孔组(n=15)和三孔组(n=30),其中双孔组患者男11例,女4例,年龄4~19个月,三孔组患者男21例,女9例,年龄3~59个月,通过秩和检验、t检验及Fisher精确检验比较手术时间、术中出血量、住院时间、住院费用及术后并发症发生率等临床参数。结果所有患者均顺利完成手术,未术中中转开放手术。与三孔组相比,双孔组患者的平均住院费用更低(31 165元vs 35 555元, t=-6.093, P<0.001,手术时间更短(40 min vs 45 min, Z=-2.322, P=0.020),住院时间更短(5 d vs 6 d, Z=-3.519, P<0.001),胸壁切口长度更短(1.0 cm vs 1.6 cm, Z=-5.489, P<0.001)。两组患者术中出血量及术后并发症的发生率差异无统计学意义。结论单术者双孔法在微创电视胸腔镜手术治疗儿童叶外型肺隔离症中操作简便、安全可行,可缩短患者的手术时间及住院时间、减小患者胸壁切口的长度、节省患者的住院费用,更加符合当今加速康复外科的理念,值得临床进一步推广应用。

关键词: 双孔胸腔镜, 叶外型肺隔离症, 儿童, 微创, 加速康复外科

Abstract: Objective To summarize the operation process of “single-surgeon double-incision method” in video-assisted thoracoscopic surgery in the treatment of the children with extralobar sequestration, and to evaluate the feasibility and safety of this operation. Methods The clinical data of 45 patients operated on by the same surgeon in the Childrens Hospital Affiliated to Shandong University during Jan. 2020 and Aug. 2023 were retrospectively collected. According to different surgical methods, the patients were divided into double-incision group(n=15, 11 males and 4 females, aged 4 to 19 months)and three-incision group(n=30, 21 males and 9 females, aged 3 to 59 months). The operation time, intraoperative blood loss, hospital stay, hospital costs and incidence of postoperative complications were compared with rank-sum test, t test and Fisher exact test. Results All operations were successfully completed, without conversion to open surgery. The double-incision group had lower hospital costs(31,165 vs. 35,555 Yuan, t=-6.093, P<0.001), shorter operation time(40 vs. 45 min, z=-2.322, P=0.020), shorter hospital stay(5 vs. 6 d, z=-3.519, P<0.001), and shorter length of chest wall incision(1.0 vs. 1.6 cm, z=-5.489, P<0.001). There were no significant differences in the amount of intraoperative blood loss and incidence of postoperative complications between the two groups. Conclusion Single-surgeon double-incision method is simple, safe and feasible in minimally invasive video-assisted thoracoscopic surgery in the treatment of the children with extralobar sequestration, which reduces the operation time, hospital stay, length of chest wall incision, and hospital costs. It is in line with the concept of enhanced recovery after surgery, and worthy of promotion and application in clinical practice.

Key words: Double-incision thoracoscope, Extralobar sequestration, Children, Minimally invasive, Enhanced recovery after surgery

中图分类号:

R615

吕龙飞,李继如,翟允鹏,赵华善,郭锐,许洪修,黄赛,张士松. 单术者双孔法在电视辅助胸腔镜手术治疗儿童叶外型肺隔离症中的早期临床应用[J]. 山东大学学报 (医学版), 2024, 62(1): 57-62.

LYU Longfei, LI Jiru, ZHAI Yunpeng, ZHAO Huashan, GUO Rui, XU Hongxiu, HUANG Sai, ZHANG Shisong. Early clinical application of “single-surgeon double-incision method” in video-assisted thoracoscopic surgery in the treatment of the children with extralobar sequestration[J]. Journal of Shandong University (Health Sciences), 2024, 62(1): 57-62.

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