电视胸腔镜在小儿胸外科中的临床应用

目的探讨电视胸腔镜手术(VATS)在小儿胸部疾病诊治中的应用价值. 方法对41例平均年龄6.9岁(9 d～16岁),平均体重22.5 kg(2.8～54.0 kg)的患儿施行VATS,其中14例＜5岁.手术包括脓胸清除 15例、纵隔肿瘤活检或摘除11例,肺楔形切除6例,肺囊肿或肺隔离症行肺叶切除5例、血胸清除与先天性膈疝处理各2例. 结果全组患者平均手术时间 74 min,平均失血量33 ml(10～220 ml).术后留置胸腔引流管平均2.4 d,平均住院7 d(4～15 d).术后并发症发生率7.3%,手术病死率2.4%.40例患儿术后随访15.6个月(2.0～30.0个月),生长发育良好.结论 VATS能安全有效地用于小儿胸部疾病的诊断和治疗,这一新技术将在小儿胸外科占有重要的地位.

Clinical practice of video-assisted thoracoscopic surgery in children

Objective To estimate the value of video assisted thoracoscopic surgery (VATS) in diagnosis and treatment of children with chest diseases Methods From May 1997 to October 2001, forty one children (25 boys and 16 girls) with chest diseases recieved VATS under general anesthesia in our hospital Their average age was 6 9 years (range 9 days to 16 years) and their median body weight was 22 5 kg (2 8 54 0 kg) Operative procedures included fibrinopurulent empyema with debridement and decortication in 15 children, biopsy and(or) resection of mediastinal tumor in 11, bullectomy and cystectomy of the lung in 6, lobectomy with huge cyst of the lung or sequestration in 5, cleanance of hemothorax in 2, and exploration, and repair of diaphragmatic hernia in 2 Results The mean operative time was 74 minutes (range 30 to 220 minutes) The lost blood volume was 33 ml (range 10 to 150 ml). The mean duration of chest drainge and hospital stay after surgery was 2 4 days and 7 0 days (range 4 to 15 days) respectively. One infant born after 9 days with congenital diaphragmatocele died of respiratory failure due to left pulmonary hypoplasia 10 days after operation Postoperative morbidity was 7 3% (3 patients) Forty patients were followed up for an average of 15 6 months, 38 patients lived and developed normally, and 2 received chemotherapy Conclusion Video assisted thoracoscopy is a safe and effective diagnostic and therapeutic procedure for children with chest disease, and this approach has an important place in pediatric thoracic surgery