目的：探讨腔镜下胸锁乳突肌始端切断松解术在小儿先天肌性斜颈中的临床应用价值。方法：对10例1~8岁斜颈患儿于患侧腋窝前缘顶端置入10 m套管针（trocar），在胸锁乳突肌胸骨头、锁骨头浅部及颈阔肌筋膜下建立皮下操作空间，充入CO2气体加压至6 mm Hg（1 mm Hg=0.133 kPa）。分别在病变侧颈后近端锁骨上缘处及对侧胸壁近端锁骨下缘穿刺置入5 mm trocar至颈前皮下间隙，并置入分离钳与电凝钩，分次电凝横断胸锁乳突肌胸骨头、锁骨头的肌纤维及周围的纤维结缔组织，直至显露出颈血管鞘与肩胛舌骨肌。术后第1天佩戴颈托进行矫正。结果：10例手术均顺利完成，无一例中转开放，术中术后无严重并发症及复发病例，手术时间为45~120 min，平均时间为55 min，术中出血较少，术后住院时间2~3 d，平均2.5 d，随访1~12个月，疗效满意。结论：腔镜下胸锁乳突肌切断松解术治疗先天性肌性斜颈疗效好，操作简单，真正做到颈部无瘢痕，具有一定的可行性和推广性。%Objective:To discuss the clinical value of the sternocleidomastoid cut loose solution treatment of congenital muscular torticollis under the cavity mirror in child.Method:10 children with the age ranged from 1 to 8 years congenital torticollis were treated. A 10 mm trocar was inserted in the top of the front side armpit, the subcutaneous operating space was established in the sternal head of sternocleidomastoid, shallow head of clavicular, and platysma fascia, the subcutaneous space was established with CO2, inflation at the pressure of 6 mm Hg(1 mm Hg=0.133 kPa).A 5 mm trocar was inserted in the subcutaneous anterior portion clearance, covering elastic separating plier and electrocantery, sternal head of sternocleidomastoid, shallow head of clavicular and the around fibrous connection tissue covering by the electric coagulation, up to appear neck rascular sheath and omohyoid. Postoperative 1 day wear neck collar was used to correct.Result:The operation was successfully completed under endoscope in all children and it was no serious complication reappear case in intraoperation and postoperation, the operation time range from 45 to 120 min, averaged 55 min, less intraoperative blood loss. 2-3 d was in hospital in postoperation, an average of 2.5 d, followed-up from 1 to 12 months showed satisfactory effect. Conclusion: The sternocleidomastoid cut loose solution treatment of congenital muscular torticollis under the cavity mirror has a good effect in a safe and relatively quick procedure. It provides a good cometic outcomes and avoids injure to neurovascular structures.
展开▼
