目的 总结胸腔镜手术治疗小儿纵隔前肠源性囊肿的经验。方法 2019年7月～2023年7月我科采用侧胸入路全胸腔镜手术(三孔法)治疗纵隔前肠源性囊肿27例，健侧卧位，观察孔为肩胛下第5肋间，另外2个操作孔根据病变位置及腔镜菱形法建立，均为5 mm trocar，CO2气胸压力6 mm Hg。电钩打开囊肿脏层胸膜，肠钳固定牵拉囊肿，分离钳、电钩交替分离将囊肿完整剥除。结果 无中转开胸。完整切除26例，残留部分囊壁1例。打开食管肌层9例。5例囊肿遮挡手术视野，不利于观察，穿刺囊肿抽液。手术时间45～120 min(中位时间70 min)。出血量3～10 ml(中位数5 ml)。术后住院时间2～5 d(中位数3 d)。 27例随访1～43个月(中位数22个月)，均无复发;2例被压迫的气管全部恢复，肺气肿均恢复。结论 胸腔镜手术治疗小儿纵隔前肠源性囊肿安全可行，若病变周围结构较为复杂，必要时可联合支气管镜或胃镜手术。
Thoracoscopic Treatment of 27 Cases of Anterior Mediastinal Enterogenous Cysts in Children
Objective To summarize the clinical experience of thoracoscopic treatment of anterior mediastinal enterogenous cysts.Methods From July 2019 to July 2023,27 children diagnosed as having anterior mediastinal enterogenous cysts were treated with total thoracoscopic surgery through the lateral thoracic approach(three port method)in our department.The patients were placed in a healthy lateral position.The observation hole was located in the 5th intercostal space under the scapula,and the other 2 operating holes were established based on the location of the lesion and the endoscopic diamond-shaped method,both of which were 5 mm trocars.The CO2 pneumothorax was established at a pressure of 6 mm Hg.The visceral pleura of the cyst was opened with an electric hook,the cyst was fixed and pulled by intestinal forceps,and the cyst was completely removed by forceps and electric hook separation alternately.Results No conversion to thoracotomy was required.Complete resection was performed in 26 cases,and residual cyst wall existed in 1 case.Esophageal muscular layer was opened in 9 cases.During the operation,cysts obstructed the surgical field of view in 5 cases,which was not conducive to observation.The cyst puncture and fluid extraction were performed.The operation time was 45-120 min(median,70 min).The amount of blood loss was 3-10 ml(median,5 ml).Postoperative hospitalization lasted for 2-5 d(median,3d).The 27 cases were followed up for 1-43 months(median,22 months),and there was no recurrence.The compressed trachea in 2 cases was all recovered,with emphysema fully recovered.Conclusions Thoracoscopic treatment of anterior mediastinal enterogenous cysts in children is safe and feasible.When the surrounding structure of the lesion is complex,it can be combined with bronchoscopic or gastroscopic surgery if necessary.
万方数据
维普
