胸腔镜下心包开窗术对小儿心包积液的诊治价值

Value of thoracoscopic pericardial window in diagnosis and treatment of pericardial effusion in children

摘要:

目的：总结胸腔镜下心包开窗术诊治儿童心包积液的经验，探讨其临床价值。方法：回顾性分析2012年1月～2018年5月我院实施的63例胸腔镜下心包开窗术患儿的临床资料。本组男性39例，女性24例，年龄7.0～194.0月，平均（93.60±43.70）月；体质量2.95～51.00 kg，20.00（17.00，28.00） kg；病程2～180 d，10（5，27） d。本组中量心包积液15例，大量心包积液48例。结果：63例患儿胸腔镜下心包开窗4～30 cm2，6（4，11） cm2；术中出血量1～50 mL，5（2，5） mL；手术时间15～310 min，65（40，90） min。本组中转开放手术4例，同期行胸腔积液引流53例，胸膜剥脱15例。术后呼吸机使用时间0.00～480.00 h，0（0，1.50） h。监护室停留时间0～27 d，3（2，4） d，引流管安置时间2～39 d，5（4，9） d，术后住院时间5.0～57.0 d，11.0（10，15.5） d。本组患儿疼痛评分0～4分，1（0，2）分。本组病因诊断：化脓性4例（6.3%），肺吸虫性34例（54.0%），结核性3例（4.8%），特发性18例（28.6%），乳糜性3例（4.8%），T淋巴母细胞淋巴瘤1例（1.6%），其中心包病理检查明确诊断39例（61.90%）。术后并发症：肺不张2例，术后出血非预期再手术1例。本组62例治愈出院。56例患儿获得6～24月的随访，无心包积液复发及心包缩窄发生。结论：儿童胸腔镜下心包开窗术创伤较小，术后疼痛轻，切口美观，可获得心包的病理诊断，安全有效，有条件的医院可以作为儿童中、大量心包积液的首选诊治方案。

Abstract:

Objective：To investigate the clinical value of thoracoscopic pericardial window（TPW） in the diagnosis and treatment of pericardial effusion in children by summarizing related experience. Methods：A retrospective analysis was performed for the clinical data of 63 children who underwent TPW surgery in our hospital from January 2012 to May 2018. There were 39 boys and 24 girls，aged 7.0-194.0 （93.60±43.70） months，with a body weight of 2.95-51.00 kg[20.00（17.00，28.00） kg] and a course of disease of 2-180 days[10（5，27） days]. Of all children，15 had moderate pericardial effusion and 48 had severe pericardial effusion. Results：For these 63 children，the area of TPW was 4-30 cm2[6（4，11） cm2]，intraoperative blood loss was 1-50 mL[5（2，5） mL]，and the time of operation was 15-310 minutes[65（40，90） minutes]. Of all children，4 were converted to open surgery，53 underwent pleural effusion drainage，and 15 underwent pleural exfoliation during the same period. The duration of postoperative mechanical ventilation was 0.00-480.0 hours[0.00（0.00，1.50） hours]. The children stayed in the intensive care unit for 0-27 days[3（2，4） days]，with a duration of chest tube drainage of 2-39 days[5（4，9） days] and a length of postoperative hospital stay of 5.0-57.0 days[11.0（10，15.5） days]. The pain score for all children ranged from 0 to 4 points[1（0，2） points]. The etiological diagnosis showed pyogenic effusion in 4 children（6.3%），paragonimiasis pericarditis in 34 children（54.0%），tuberculous effusion in 3 children（4.8%），idiopathic effusion in 18 children（28.6%），chylopericardium in 3 children（4.8%），and T lymphoblastic lymphoma in 1 child（1.6%）. Of all children，39（61.90%） had a confirmed diagnosis based on pathological examination. As for postoperative complications，2 children experienced atelectasis and 1 experienced postoperative hemorrhage and was given surgical treatment. A total of 62 children were cured and discharged. A total of 56 children were followed up for 6-24 months，and no recurrence of pericardial effusion or pericardial constriction was observed. Conclusion：TPW for children has the advantages of little trauma，mild postoperative pain，and small incision and can be used to obtain the pathological diagnosis of pericardial effu－sion. It is safe and effective and can be used as the preferred diagnostic and therapeutic regimen for children with moderate or severe pericardial effusion in qualified hospitals.