胸腔镜手术与开胸手术治疗先天性支气管囊肿的对比分析

目的总结传统开胸手术与胸腔镜手术治疗先天性支气管囊肿的经验,分析两种手术的可行性及优劣。方法回顾性分析本院自2013年1月至2叭5年11月收治的先天性支气管囊肿患儿临床资料。患儿均经产前超声检查获得初步诊断,经产前评估及出生后增强CT检查明确诊断,最后经手术确诊。手术方式分为传统开胸手术及胸腔镜手术,比较两组手术时间、术中出血量、住院时间及胸腔引流管留置情况,探讨小儿胸腔镜手术治疗支气管囊肿的可行性及风险。结果共13例确诊,12例手术,1例家属决定暂不手术。手术病例中,女性6例,男性6例,男:女=1:1。左右侧比为1:1,其中6例手术诊断为支气管囊肿,3例合并肺囊腺瘤,3例合并肺隔离症。5例术前准确诊断为支气管囊肿,7例诊断为肺囊腺瘤或肺隔离症。手术年龄最小5 d,最大1岁,平均手术年龄4.8个月。5例采取传统开胸手术;7例采取胸腔镜手术,其中1例2月龄患儿因术中须行肺叶切除而增加辅助切口。所有手术病例均治愈。结论先天性支气管囊肿属于少见疾病,由于存在感染以及占位的风险,建议早期手术。胸腔镜下操作,对于婴幼儿病例,不会增加手术风险,是一种可行的手术方式。

Comparative analyses of mini-invasive versus open surgery for congenital bronchial cyst

Objetive To explore the feasibility and advantages of traditional open versus mini-invasive surgery for congenital bronchial cyst. Methods From January 2013 to January 2015,retrospective reviews of clinical data were conducted for children of congenital bronchial cyst.Based on prenatal ultrasonic diagnosis,a definite diagnosis was made by postnatal computed tomography (CT)and pathological examination.Traditional open and mini-invasive surgery were compared with regards to operative duration,blood loss volume,length of stay and placement of irrigation tube. Results Among 13 cases of congenital bronchial cyst,12 were opera-ted.There were 6 females and 6 males.The involved sides were left (n =6)and right (n =6).The diagnoses were bronchial cyst (n =6),combined with congenital cystic adenomatoid malformations (CCAM,n =3)and combined with pulmonary sequestration (n =3).Five prenatal cases were suggestive of bronchial cysts while others hinted at congenital cystsic adenomatoid malformation or pulmonary sequestration in fetuses.The average operative age was 4.8 months (5 days to 1 year).The procedures included traditional open chest surgery (n =5) and thoracoscopic surgery (n =7).One 2-month-old child required accessorial incision due to lobectomy.All surgical cases were cured. Conclusions As a rare disease,congenital bronchial cyst carries the risks of infec-tion and space-occupying so that early surgery is recommended.Thoracoscopy is feasible for infants and young children and it does not increase the risk of surgery.