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胸腔镜手术与开胸手术治疗先天性食管闭锁伴气管食管瘘的疗效对比

左伟 刘翔 高威 张燕敏 赵萍 吴公景 李清智 王夫龙

左伟, 刘翔, 高威, 张燕敏, 赵萍, 吴公景, 李清智, 王夫龙. 胸腔镜手术与开胸手术治疗先天性食管闭锁伴气管食管瘘的疗效对比[J]. 中华全科医学, 2021, 19(9): 1492-1496. doi: 10.16766/j.cnki.issn.1674-4152.002094
引用本文: 左伟, 刘翔, 高威, 张燕敏, 赵萍, 吴公景, 李清智, 王夫龙. 胸腔镜手术与开胸手术治疗先天性食管闭锁伴气管食管瘘的疗效对比[J]. 中华全科医学, 2021, 19(9): 1492-1496. doi: 10.16766/j.cnki.issn.1674-4152.002094
ZUO Wei Wei, LIU Xiang Xiang, GAO Wei, ZHANG Yan-min, ZHAO Ping, WU Gong-jing, LI Qing-zhi, WANG Fu-long. Outcomes of thoracoscopy versus thoracotomy for oesophageal atresia with tracheoesophageal fistula repair[J]. Chinese Journal of General Practice, 2021, 19(9): 1492-1496. doi: 10.16766/j.cnki.issn.1674-4152.002094
Citation: ZUO Wei Wei, LIU Xiang Xiang, GAO Wei, ZHANG Yan-min, ZHAO Ping, WU Gong-jing, LI Qing-zhi, WANG Fu-long. Outcomes of thoracoscopy versus thoracotomy for oesophageal atresia with tracheoesophageal fistula repair[J]. Chinese Journal of General Practice, 2021, 19(9): 1492-1496. doi: 10.16766/j.cnki.issn.1674-4152.002094

胸腔镜手术与开胸手术治疗先天性食管闭锁伴气管食管瘘的疗效对比

doi: 10.16766/j.cnki.issn.1674-4152.002094
基金项目: 

安徽省卫生健康委科研计划项目 2019SEY007

详细信息
    通讯作者:

    左伟, E-mail: zuowei19790614@163.com

  • 中图分类号: R726.1  R562.13

Outcomes of thoracoscopy versus thoracotomy for oesophageal atresia with tracheoesophageal fistula repair

  • 摘要:   目的  对比胸腔镜手术和开胸手术治疗先天性食管闭锁伴气管食管瘘的临床疗效。   方法  选取安徽省儿童医院2011年3月—2019年2月间行手术治疗的101例先天性食管闭锁伴气管食管瘘患儿,按手术方式分为胸腔镜组(50例)和开胸组(51例),分析2组患儿术前资料、围手术期相关指标及术后恢复情况。同时依据学习曲线将胸腔镜组患儿分为前期、后期(各25例),并对上述指标进行比较。   结果  (1) 2组患儿术前临床资料比较差异无统计学意义(均P>0.05)。(2)围手术期指标:胸腔镜组平均手术时间[(191.42±48.56)min]长于开胸组[(129.02±25.08)min],差异有统计学意义(t=8.163,P<0.001);胸腔镜组术后初次经口喂养时间[(11.98±2.92)d]短于开胸组[(16.88±4.33)d],差异有统计学意义(t=-2.364,P=0.020)。(3)2组术后吻合口漏、吻合口狭窄发生率及气管食管瘘管复发率比较差异无统计学意义(均P>0.05)。(4)胸腔镜组后期手术时间、术后带机时间均较前期缩短,差异均有统计学意义(均P<0.05),术后吻合口漏发生率也明显下降,但差异无统计学意义(P>0.05)。   结论  胸腔镜手术治疗先天性食管闭锁与开胸手术效果相当,且随着手术技巧的不断改进和完善,临床疗效更为确切。

     

  • 图  1  开胸手术

    注:A示体位为左侧卧位,前倾30°;B为游离远端气管食管瘘管;C为完成食管吻合。

    图  2  胸腔镜手术

    注:A示体位为左侧卧位,前倾30°;B为结扎气管食管瘘管;C为冠状位剪开近端食管盲端;D为纵行剪开远端食管瘘管;E为完成食管吻合。

    表  1  2组先天性食管闭锁伴气管食管瘘患儿术前一般资料比较

    组别 例数 性别(男/女, 例) 孕周(x±s, 周) 手术日龄(x±s, d) 体重(x±s, kg) 分型(Ⅲb/Ⅲa, 例) 合并畸形(例)
    胸腔镜组 50 29/21 38.82±1.71 4.42±3.10 2.76±0.48 39/11 32
    开胸组 51 37/14 38.59±1.88 4.38±3.17 2.77±0.43 38/13 35
    统计量 2.360a 0.665b 0.214b -0.196b 0.170a 0.242a
    P 0.124 0.518 0.954 0.886 0.680 0.623
    注:aχ2值,bt值。
    下载: 导出CSV

    表  2  2组先天性食管闭锁伴气管食管瘘患儿围手术期指标及并发症发生情况比较

    组别 例数 手术时长(x±s, min) 术后带机时间(x±s, h) 术后初次经口喂养时间(x±s, d) 术后住院天数(x±s, d) 吻合口漏[例(%)] 吻合口狭窄[例(%)] 气管食管瘘复发[例(%)] 胸腔/肺部并发症[例(%)]
    胸腔镜组 50 191.42±48.56 81.82±28.58 11.98±3.92 24.54±5.35 6(12.0) 8(16.0) 4(8.0) 2(4.0)
    开胸组 51 129.02±25.08 57.52±26.65 16.88±4.33 27.42±5.49 12(23.5) 5(9.8) 1(1.9) 3(5.9)
    统计量 8.163a 4.420a 5.958a 2.670a 2.292b 0.864b 0.884b < 0.001b
    P < 0.001 < 0.001 < 0.001 0.009 0.130 0.670 0.347 0.999
    注:at值,bχ2值。
    下载: 导出CSV

    表  3  胸腔镜组先天性食管闭锁伴气管食管瘘患儿围手术期指标及并发症发生情况比较

    组别 例数 手术时长(x±s, min) 术后带机时间(x±s, h) 术后初次经口喂养时间(x±s, d) 术后住院天数(x±s, d) 吻合口漏[例(%)] 吻合口狭窄[例(%)] 气管食管瘘复发[例(%)]
    胸腔镜组后期 25 177.44±32.14 55.28±10.48 9.52±2.83 22.92±4.27 1(4.0) 3(12.0) 2(8.0)
    胸腔镜组前期 25 205.40±28.09 107.12±11.42 14.36±4.75 26.25±4.46 5(20.0) 5(20.0) 2(8.0)
    统计量 3.275a 16.723a 4.377a 2.697a 1.705b 0.149b
    P 0.002 < 0.001 < 0.001 0.010 0.192 0.700
    注:at值,bχ2值。
    下载: 导出CSV
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  • 收稿日期:  2020-09-18
  • 网络出版日期:  2022-02-15

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