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Objective:To investigate the clinical efficacy of laparoscopic adrenalectomy and traditional open adrenalectomy for adrenal tumors in children.Methods:In Department of Pediatric Surgery, Fujian Provincial Maternity and Children′s Hospital from June 2008 to June 2016, the clinical data of 31 pediatric adrenal tumors was retrospectively analyzed.According to different surgical methods, they were divided into traditional open adrenalectomy group and laparoscopic adrenalectomy group.Bleeding loss, operation duration, incision length, abdominal drainage time, postoperative hospital stay, postoperative complications and recurrence were compared between the 2 groups.Results:There was no significant difference in age, sex, weight, and tumor size between the 2 groups (all P>0.05). The intraoperative bleeding loss was (18.06±4.86) mL for open adrenalectomy group and (15.20±4.48) mL for laparoscopic adrenalectomy group, and there existed no significant difference in the amount of bleeding between the 2 groups( T=-1.702, P>0.05). The operation duration was (137.44±19.32) min for open adrenalectomy group versus (134.80±6.21) min for laparoscopic adrenalectomy group, and there was no significant difference in operation duration between the 2 groups ( T=-0.504, P>0.05). The length of incision was (7.94±1.34) cm for open adrenalectomy group versus (3.44±0.21) cm for laparoscopic adrenalectomy group, the length of incision in laparoscopic group was shorter than that in open adrenalectomy group.There was significant difference in the length of incision between the 2 groups ( T=-12.843, P<0.001). The hospitalization time was (9.63±2.55) d for open adrenalectomy group versus (7.20±1.37) d for laparoscopic adrenalectomy group, the hospitalization time in laparoscopic group was shorter than those in open adrenalectomy group.The difference of operation time between the 2 groups was statistically significant ( T=-3.261, P=0.003). The average indwelling time of abdominal drainage tube was(5.94±1.53) d for open adrenalectomy group versus (4.80±1.74) d for laparoscopic adrenalectomy group, with no significant difference in postoperative abdominal drainage time between the 2 groups( T=-1.938, P>0.05). There was 1 case of retroperitoneal hematoma in laparoscopic adrenalectomy group and 2 cases of complications in open adrenalectomy group.There was no significant difference in the incidence of complications between the 2 groups ( P=1.000). There were 3 cases of distant metastasis and 1 case of recurrence in laparoscopic group, and 2 cases of distant metastasis and 1 case of recurrence in open adrenalectomy group.There was no significant difference in recurrence between the 2 groups ( P=1.000). Conclusions:Compared with open adrenalectomy surgery, laparoscopic adrenalectomy in children has various advantages, including beautiful incision, less trauma and fast recovery.However, it is necessary to select the appropriate cases.
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Objective To investigate the difference in the clinical efficacy by thoracoscopy or thoracotomy for treating esophageal atresia.Methods Thirty-one cases of type-Ⅲ esophageal atresia undergoing surgical treatment from February 2015 to May 2018 at the Department of Pediatric Surgery of Fujian Provincial Maternity and Children's Hospital were included,and according to the different surgical methods they were divided into thoracoscopic group (15 cases) and thoracotomy group (16 cases).The operation duration,blood loss,postoperative chest drainage time,postoperative hospital stay and postoperative complications were analyzed between 2 groups.Results The mean time of operation was (181.33 ± 13.86) min in the thoracoscopic surgery group and (139.06 ± 10.98) min in the thoracotomy group,the thoracoscopie group had longer operation duration than thoracotomy group,and there was a significant difference in operation duration between two groups (t =9.44,P =0.000);mean blood loss was (3.07 ± 0.96) mL in the thoracoscopic surgery group and (5.06 ± 1.12) mL in the thoracotomy group,the thoracoscopic group had less amount of blood loss than thoracotomy group,and there was a significant difference in blood loss between two groups(t =-5.29,P =0.000);mean postoperative chest drainage time was (11.67 ± 1.34) d in the thoracoscopic group and (12.25 ± 1.06) d in the thoracotomy group,and there was no significant difference in postoperative chest drainage time between two groups (t =-1.34,P =0.19);mean time of postoperative hospitalization time was (15.20 ± 0.94) d in the thoracoscopic group and (16.00 ±0.96) d in the thoracotomy group,and there was a significant difference in the postoperative hospitalization time between two groups (t =-2.33,P =0.027);the anastomotic leak rates were 33.33％ (5 cases) versus 25.00％ (4 cases) with closed or open approaches,respectively;anastomotic stricture rates were 40.00％ (6 cases) versus 31.25％ (5 cases) with closed or open approaches,respectively.There was no significant difference in postoperative incidence of anastomotic fistula and anastomotic stenosis between two groups.Conclusions Compared with thoracotomy in the treatment of esophageal atresia,thoracoscopic approach has smaller incision and less bleeding,less chest deformity,short hospital stay postoperatively,so it is safe and effective.However,the surgeon must have experience in doing thoracoscopie operation.
ABSTRACT
Objective@#To investigate the difference in the clinical efficacy by thoracoscopy or thoracotomy for treating esophageal atresia.@*Methods@#Thirty-one cases of type-Ⅲ esophageal atresia undergoing surgical treatment from February 2015 to May 2018 at the Department of Pediatric Surgery of Fujian Provincial Maternity and Children′s Hospital were included, and according to the different surgical methods they were divided into thoracoscopic group (15 cases) and thoracotomy group (16 cases). The operation duration, blood loss, postoperative chest drainage time, posto-perative hospital stay and postoperative complications were analyzed between 2 groups.@*Results@#The mean time of operation was (181.33±13.86) min in the thoracoscopic surgery group and (139.06±10.98) min in the thoracotomy group, the thoracoscopic group had longer operation duration than thoracotomy group, and there was a significant difference in operation duration between two groups (t=9.44, P=0.000); mean blood loss was (3.07±0.96) mL in the thoracoscopic surgery group and (5.06±1.12) mL in the thoracotomy group, the thoracoscopic group had less amount of blood loss than thoracotomy group, and there was a significant difference in blood loss between two groups(t=-5.29, P=0.000); mean postoperative chest drainage time was(11.67±1.34) d in the thoracoscopic group and (12.25±1.06) d in the thoracotomy group, and there was no significant difference in postoperative chest drainage time between two groups(t=-1.34, P=0.19); mean time of postoperative hospitalization time was(15.20±0.94) d in the thoracoscopic group and (16.00±0.96) d in the thoracotomy group, and there was a significant difference in the postoperative hospitalization time between two groups (t=-2.33, P=0.027); the anastomotic leak rates were 33.33% (5 cases) versus 25.00% (4 cases) with closed or open approaches, respectively; anastomotic stricture rates were 40.00%(6 cases) versus 31.25% (5 cases) with closed or open approaches, respectively.There was no significant difference in postoperative incidence of anastomotic fistula and anastomotic stenosis between two groups.@*Conclusions@#Compared with thoracotomy in the treatment of esophageal atresia, thoracoscopic approach has smaller incision and less bleeding, less chest deformity, short hospital stay postoperatively, so it is safe and effective.However, the surgeon must have experience in doing thoracoscopic operation.