Lawal Taiwo A, Gosemann Jan-H, Kuebler Joachim F, Glüer Sylvia, Ure Benno M
Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany.
Ann Thorac Surg. 2009 Jan;87(1):224-8. doi: 10.1016/j.athoracsur.2008.08.069.
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.
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.
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.
The thoracoscopic versus conventional approach to the thoracic cavity in children is associated with significantly less midterm musculoskeletal sequelae and a better cosmetic outcome.
据推测，电视辅助胸腔镜手术（VATS）比传统开胸手术（CTS）能取得更好的生物测量和美学效果，但缺乏相关数据。我们旨在比较这两种手术方式对儿童的中期影响。
62例因良性胸部疾病接受VATS（34例；55%）或CTS（28例；45%）的婴幼儿和儿童，在平均3.8年（1至7年）的随访中接受评估。患者接受了骨骼系统和功能的标准化临床评估。通过超声检查肋间间隙是否存在肋骨融合。患者（±父母）以及临床医生随后对瘢痕进行了评估。
与未手术侧相比，VATS术后胸腔在水平面的不对称发生率显著低于CTS（平均相对差异0.996±0.003对0.964±0.008，p<0.001），乳头位置的不对称发生率也较低（平均相对差异0.985±0.008对0.949±0.013，p=0.047）。肩关节活动范围无显著差异。然而，VATS患者脊柱侧弯的发生率较低（9%对54%，p<0.001），CTS术后患侧半胸的肋间间隙更窄（p<0.001）。曼彻斯特瘢痕评估评分更倾向于VATS（平均7.5对13.1，p<0.001）。患者-父母和独立观察者记录的视觉模拟量表评分在VATS术后也显著更好。CTS术后患者满意度较低，因为10%的患者希望修改瘢痕，而VATS组无人有此需求。
儿童胸腔镜手术与传统开胸手术相比，中期肌肉骨骼后遗症显著更少，美容效果更好。
