单操作孔与全胸腔镜在小儿纵膈肿瘤手术中的应用比较

目的探讨单操作孔手术与全胸腔镜手术在小儿纵膈肿瘤治疗中的效果。 方法回顾性分析2014年1月至2017年6月武汉市儿童医院心胸外科收治的46例纵膈肿瘤患儿临床资料。根据手术方式不同将患儿分为2组，A组为全胸腔镜手术组，共29例患儿；B组为单操作孔手术组，共17例患儿，2组患儿年龄、体质量、肿瘤大小、类型等差异无统计学意义。分析比较2组患儿手术时间、术中出血量、胸腔引流时间、手术后住院时间和手术后并发症等。 结果46例患儿均顺利完成手术，A组中转开胸2例，B组无中转开胸，术后5例带气管插管回ICU。A组平均手术时间（69.35±8.24）min，较B组平均手术时间［（72.80±6.28）min］短，差异具有统计学意义（P<0.05），术中出血量2组间比较［（21.47±6.85）ml vs（27.52±4.15）ml］差异无统计学意义；A组患儿平均胸腔引流时间、手术后住院时间较B组略长，分别为（5.46±1.72）d vs （4.68±1.39）d，（6.93±1.34）d vs（5.92±1.67）d。2组患儿术后均无严重并发症，恢复顺利。 结论与全胸腔镜手术相比，单操作孔手术治疗小儿纵隔肿瘤，具有创伤小、恢复快等优点，但手术耗时较长。

Single port versus total thoracoscopic surgery for treatment of pediatric mediastinal tumors

ObjectiveTo compare the therapeutic efficacy of single port versus total thoracoscopic surgery in the treatment of pediatric mediastinal tumors. MethodsFrom January 2014 to June 2017, 46 children with mediastinal tumors who underwent surgical treatment were divided into two groups according to the operative approach used: A and B. Age, body weight, and tumor size were compared between the two groups. Group A (n=29) underwent single port video-assisted thoracoscopic surgery, while group B (n=17) underwent total thoracoscopic surgery. Operative duration, intraoperative blood loss, postoperative drainage time, hospitalization time, and postoperative complications of the two groups were recorded and compared. ResultsThe average operative duration was significantly shorter in group A than in group B (69.35±8.24) min vs (72.80±6.28) min] (P<0.05) . The volume of intraoperative blood loss was similar between the two groups (21.47±6.85) mL vs (27.52±4.15) mL]. Mean postoperative drainage time and hospitalization time of group A were slightly longer than those of group B (5.46±1.72) days vs (4.68±1.39) days, (6.93±1.34) days vs (5.92±1.67) days]. All operations were successfully completed. There was two cases of conversion to thoracotomy in group A. No severe complications occurred in either group. ConclusionCompared with total thoracoscopic surgery, single port video-assisted thoracoscopic surgery offers the advantages of smaller incision and faster recovery for mediastinal tumors under 5 cm; however, the latter is more time-consuming.