Thoracoscopy Versus Thoracotomy Improves Midterm Musculoskeletal Status and Cosmesis in Infants and Children
Thoracoscopy Versus Thoracotomy Improves Midterm Musculoskeletal Status and Cosmesis in Infants and Children
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DOI：
10.1016/j.athoracsur.2008.08.069
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发表时间：
2009-01-01
影响因子：
4.6
通讯作者：
Ure, Benno M.
中科院分区：
文献类型：
--
作者：
Lawal, Taiwo A.;Gosemann, Jan-H.;Ure, Benno M.
背景据推测，视频辅助胸腔镜手术（VATS）实现了更好的生物统计学和美学的结果比传统的胸部手术（CTS），但缺乏数据。我们的目的是比较这两种方法在儿童中的中期效果。62名因良性胸部疾病接受VATS（34; 55%）或CTS（28; 45%）的婴儿和儿童在平均3.8年（1至7年）的随访时接受了评估。患者接受了骨骼系统和功能的标准化临床评估。超声检查肋间间隙以确定肋骨融合。患者（+/-父母）自己，以及临床医生，随后评估疤痕。手术侧与非手术侧相比，VATS后胸部不对称的发生率明显低于水平面上的CTS（平均相对差异0.996 +/- 0.003 vs 0.964 +/- 0.008，p < 0.001）和乳头位置（平均相对差异0.985 +/- 0.008 vs 0.949 +/- 0.013，p = 0.047）。肩关节的活动范围没有显着差异。而VATS组的脊柱侧凸发生率较低（9%比54%，P < 0.001），CTS后手术侧肋间隙较术前明显缩小（P < 0.001）。Manchester瘢痕评估评分有利于VATS（平均7.5 vs 13.1，p < 0.001）。VATS后，患者父母和独立观察者记录的视觉模拟量表评分也明显更好。CTS组患者满意度较低，10%的患者希望对瘢痕进行翻修，而VATS组无患者。胸腔镜与传统的儿童胸腔入路相比，中期肌肉骨骼后遗症明显减少，美容效果更好。
Background. It has been postulated that video-assisted thoracoscopic surgery (VATS) achieves a better biometric and aesthetic outcome than conventional thoracic surgery (CTS), but data are lacking. We aimed to compare the midterm effects of both approaches in children.Methods. Sixty-two infants and children, who underwent VATS (34; 55%) or CTS (28; 45%) for benign thoracic conditions, were evaluated at follow-up after a mean of 3.8 years (1 to 7 years). The patients underwent standardized clinical assessment of the skeletal system and function. The intercostal spaces were investigated for rib fusion by ultrasound. Patients (+/- parents) themselves, as well as clinicians, subsequently assessed the scars.Results. Comparing the operated versus nonoperated sides, chest asymmetry was significantly less frequent after VATS versus CTS in the horizontal plane (mean relative difference 0.996 +/- 0.003 vs 0.964 +/- 0.008, p < 0.001) and in nipple location (mean relative difference 0.985 +/- 0.008 vs 0.949 +/- 0.013, p = 0.047). The ranges of motion of the shoulder joints did not differ significantly. However, the incidence of scoliosis was lower in VATS patients (9% vs 54%, p < 0.001) and the intercostal spaces of the operated hemithoraces were narrower after CTS (p < 0.001). The Manchester scar assessment scores were in favor of VATS (mean 7.5 vs 13.1, p < 0.001). The visual analog scale scores recorded by patients-parents and independent observers were also significantly better after VATS. Patient satisfaction was less with CTS as 10% wanted to have the scar revised, compared with none in the VATS group.Conclusions. The thoracoscopic versus conventional approach to the thoracic cavity in children is associated with significantly less midterm musculoskeletal sequelae and a better cosmetic outcome.