Thoracoscopic diaphragmatic eventration repair in children: about 10 cases
Thoracoscopic diaphragmatic eventration repair in children: about 10 cases
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DOI：
10.1016/j.jpedsurg.2005.07.008
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发表时间：
2005-11-01
影响因子：
2.4
通讯作者：
Toledano, D
中科院分区：
文献类型：
--
作者：
Becmeur, F;Talon, I;Toledano, D
背景和目的：最近的文献报道强调了与标准开胸术相比，胸腔镜手术可减少疼痛、术后发病率和功能障碍。作者描述了一种胸腔镜的方法和技术细节，为动脉瘤突出修复在children.Patients和方法：10例患者，4名女孩和6名男孩，1名青少年（14岁）和9名儿童（年龄范围，6 - 41个月，平均17个月），进行了手术的动脉瘤突出在3个不同的儿科手术团队，根据相同的技术。症状为反复感染（7例）、劳力性呼吸困难（2例）和肋骨畸形（1例）。患者侧卧位，行择期胸腔镜检查。低二氧化碳气体注入导致肺萎陷。当折叠和折叠隔膜时，可以逐渐减少膨出。隔膜折叠采用间断缝合（6例）或连续缝合（4例）。结果：2例需中转开腹，1例因不能耐受吹气，1例因膈高于第5间隙，手术野缩小过多。患者在2 - 4天内恢复。呼吸困难立即消失。平均随访16个月，可以评估临床改善，在每一个patient.Discussion：胸腔镜下的条件是相当不同的，以前报道的疝修补术和一个eventration。对于腹股沟疝，复位很容易，为横膈疝提供了较大的手术空间。关于胸腔积液，尽管向胸膜腔注气，但在手术开始时缺乏空间仍然很重要。手术端口必须位于胸部足够高的位置，以使器械具有良好的移动性。胸腔引流似乎是不必要的。
Background and Aim: Recent reports in literature have emphasized the clinical perception of reduced pain, postoperative morbidity, and dysfunction associated with thoracoscopic approach compared with standard thoracotomy. The authors describe a thoracoscopic approach and technical details for diaphragmatic eventration repair in children.Patients and Methods: Ten patients, 4 girls and 6 boys, 1 teenager (14 years old) and 9 children (age range, 6 - 41 months; average, 17 months), were operated for a diaphragmatic eventration in 3 different pediatric surgery teams, according to the same technique. Symptoms were recurrent infection (7 cases), dyspnea on exertion (2 cases), and a rib deformity (1 case). An elective thoracoscopy was performed, patient in a lateral decubitus. A low carbon dioxide insufflation allowed a lung collapse. Reduction of the eventration was made progressively when folding and plicating the diaphragm. Plication of the diaphragm was done with an interrupted suture (6 cases) or a running suture (4 cases). The procedure finished either with an exsufflation (4 cases) or a drain (6 cases).Results: A conversion was necessary in 2 cases: 1 insufflation was not tolerated and 1 diaphragm, higher than the fifth space, reduced too much the operative field. Patients recovered between 2 and 4 days. Dyspnea disappeared immediately. Mean follow-up of 16 months could assess the clinical improvement in every patient.Discussion: Thoracoscopic conditions are quite different between a diaphragmatic hernia repair previously reported and an eventration. Concerning diaphragmatic hernias, reduction is easy, giving a large operative space for suturing the diaphragm. Concerning diaphragmatic eventrations, the lack of space remains important at the beginning of the procedure despite the insufflation into the pleural cavity. The operative ports must be high enough in the chest to allow a good mobility of the instruments. Chest drainage seems to be unnecessary.