Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Department of Pediatric Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
J Pediatr Surg. 2020 Dec;55(12):2787-2790. doi: 10.1016/j.jpedsurg.2020.06.034. Epub 2020 Jun 29.
Though conventional thoracoscopic plication is a favorable option of diaphragmatic eventration (DE), ribs limited the movement of trocars, making it difficult to suturing, knot-tying and time-consuming. The purpose of this study was to evaluate delicate surgical maneuvers and suturing time for the management of DE in robot-assisted thoracoscopic plication (RATP).
From January 2015 to November 2019, 20 patients (14 males; mean age: 10.5 ± 5.2 months; mean weight: 8.6 ± 4.5 kg) who underwent diaphragmatic plication for DE were reviewed at our institution. There were 13 patients with congenital diaphragmatic eventration and 7 patients with acquired diaphragm eventration after congenital heart surgery. RATP was performed on 9 patients (3 on the left and 6 on the right), and conventional thoracoscopic plication (CTP) was applied to 11 patients (5 on the left and 6 on the right). Demographics, the suturing time and complications were respectively evaluated.
There was no difference between 2 groups with respect to gender, age at surgery and weight (p > 0.05). No conversion to thoracotomy was needed. The suturing time in RATP group was shorter than CTP group (27.7 ± 3.4 min vs 48.1 ± 4.2 min, p < 0.001). One patient (9.09%) experienced recurrence in CTP group and none was found in RATP group.
Diaphragmatic plication with robot-assisted thoracoscopy or conventional thoracoscopy in DE has minimally invasive and good effect on children. RATP overcome the intercostal limitations to complete delicate suturing and free knot-tying, and has better ergonomics.
Level III.
尽管传统的胸腔镜折叠术是膈膨出（DE）的有利选择，但肋骨限制了套管的运动，使得缝合、打结和耗时变得困难。本研究的目的是评估机器人辅助胸腔镜折叠术（RATP）治疗 DE 的精细手术操作和缝合时间。
2015 年 1 月至 2019 年 11 月，我院对 20 例（男 14 例；平均年龄：10.5±5.2 个月；平均体重：8.6±4.5 公斤）因 DE 行膈折叠术的患者进行了回顾性研究。其中 13 例为先天性膈膨出，7 例为先天性心脏病手术后获得性膈膨出。9 例患者行 RATP（左侧 3 例，右侧 6 例），11 例患者行传统胸腔镜折叠术（CTP）（左侧 5 例，右侧 6 例）。分别评估了人口统计学资料、缝合时间和并发症。
两组在性别、手术时年龄和体重方面无差异（p＞0.05）。无需改行开胸术。RATP 组的缝合时间短于 CTP 组（27.7±3.4 分钟比 48.1±4.2 分钟，p＜0.001）。CTP 组 1 例（9.09%）患者复发，RATP 组未见复发。
机器人辅助胸腔镜或传统胸腔镜治疗 DE 的膈折叠术对儿童具有微创、效果好的特点。RATP 克服了肋间的限制，能够完成精细的缝合和自由打结，具有更好的人机工程学效果。
III 级。
