The Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
J Pediatr Surg. 2011 Dec;46(12):2397-400. doi: 10.1016/j.jpedsurg.2011.06.022.
Clinically apparent injury to an intercostal nerve associated with paralysis of the upper rectus abdominis is a rare complication of video-assisted thoracoscopic surgery (VATS), with no reports available in the pediatric literature. We present the case of a 16-year-old boy who underwent VATS blebectomy and pleurodesis followed by tube thoracostomy for recurrent spontaneous pneumothorax. Definitive reexpansion of the lung was achieved with no immediate complications, but the child complained of abnormal sensation and motor dysfunction of the left upper rectus at his first follow-up visit 2 weeks after the operation. Isolated muscular paralysis persisted at 2-month follow-up, although there was no associated activity limitation. Video-assisted thoracoscopic surgery is now a common practice and recognized as less morbid than open thoracotomy, but there exists scant literature regarding intercostal nerve injury and associated rectus abdominis paralysis. This report reviews the relevant published literature, with emphasis on the mechanism of nerve injury and avoidance of this complication.
临床明显的肋间神经损伤与上腹肌直肌瘫痪是电视辅助胸腔镜手术（VATS）的罕见并发症，儿科文献中尚无报道。我们报告了一例 16 岁男孩的病例，他因复发性自发性气胸而行 VATS 肺大疱切除术和胸膜固定术，随后进行了胸腔引流管插入术。明确的复张肺没有立即出现并发症，但患儿在手术后 2 周的第一次随访时主诉左侧上腹直肌感觉和运动功能异常。2 个月随访时仍持续孤立性肌肉瘫痪，尽管没有相关的活动受限。VATS 现在是一种常见的手术方法，被认为比开胸手术的创伤小，但有关肋间神经损伤和相关腹直肌瘫痪的文献很少。本报告回顾了相关的已发表文献，重点介绍了神经损伤的机制和避免这种并发症的方法。
