单操作孔全胸腔镜手术在儿童肺部疾病中的应用  

Application of single utility port complete video-assisted thoracoscopy for lung diseases of children

作　　者：蒋连勇[1] 谢晓[1] 胡丰庆[1] 胡睿[1] 王磊[1] 肖海波[1] 王明松[1] 李国庆[1] 丁芳宝[1] 梅举[1] Jiang Lianyong;Xie Xiao;Hu Fengqing;Hu Rui;Wang Lei;Xiao Haibo;Wang Mingsong;Li Guoqing;Ding Fangbao;Mei Ju(Department of Cardiothoracic Surgery,Affiliated Xinhua Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院心胸外科,200092

出　　处：《中华小儿外科杂志》2018年第9期660-664,共5页Chinese Journal of Pediatric Surgery

基　　金：国家自然科学基金（81372520）

摘　　要：目的 分享单操作孔全胸腔镜手术治疗儿童肺部疾病的经验.方法 回顾性分析2011年8月至2016年3月行单操作孔全胸腔镜下肺部手术23例患儿的临床资料,对其手术治疗及术后恢复情况进行分析和总结.其中,男12例,女11例;手术年龄为（8.60±4.93）岁,范围9月龄至16岁;体重为（34.57±16.24）kg,范围10～63 kg.结果本组2例因胸腔粘连辅助小切口下完成手术,余者均在单操作孔下完成手术,包括肺叶切除17次,袖式切除2次,肺段切除1次,楔形切除4次,其中1例同时行肺叶切除1次及肺楔形切除1次.手术时间为（146.57±76.83）min,范围35～345 min;术中出血为（42.39±45.12）ml,范围5～200 ml.术后病理检查提示：肺囊肿6例、肺隔离症4例、肺囊性腺瘤样畸形2例、硬化性血管瘤2例、机化性肺炎2例、支气管扩张2例、炎性肌纤维母细胞瘤1例、黏液表皮样癌1例、肺母细胞瘤1例、肺实变1例、结核性肉芽肿1例.术后引流管留置时间为（5.04±1.75）d,范围1～7 d;术后总引流量为（611.96±435.24）ml,范围50～1500 ml;日引流量为（113.44±61.54）ml,范围18～215 ml;术后住院时间为（8.35±3.05）d,范围5～17 d.住院期间出现肺部感染1例,无肺不张、活动性出血、支气管胸膜瘘等术后并发症发生.近期随访中,所有患儿均恢复良好,复查胸部CT见患侧剩余肺叶代偿良好.结论单操作孔全胸腔镜可完成儿童肺楔形、肺叶以及较复杂的袖式切除术,治疗效果满意,有较好的可行性.Objective To summarize the experiences of single utility port complete video-assisted thoracoscopy （VATS）for lung disease of children.Methods From August 2011 to March 2016,a total of 23 pediatric patients with lung diseases underwent single utility port complete VATS. Their intraoperative findings and postoperative outcomes were analyzed.There were 12 boys and 11 girls aged from 9 months to 16 years （average 8.60±4.93 years）;weighted from 10 to 63 （average 34.57±16.24）kg.Results All patients were operated under a single utility port but two assisted with small incision because of pleural adhesion,including lobectomy （n=17）,sleeve resection （n=2）, segmental resection （n = 1 ） and wedge resection （n = 4 ）.Lobectomy and wedge resection was performed in one case.The operative duration was 35-345 （average 146.57 ± 76.83 ） min and intraoperative bleeding 5-200 （average 42.39 ± 45.12 ） ml.Postoperative pathologic examinations confirmed bronchopulmonary cyst （n = 6 ）,pulmonary sequestration （n = 4 ）,congenital cystic adenomatoid malformation （n = 2 ）,sclerosing angioma （n = 2 ）,organizing pneumonia （n = 2 ）, bronchiectasis （n=2）,inflammatory myofibroblastic tumor （n = 1 ）,mucoepidermoid carcinoma （n =1）,pulmonary blastoma （n=1）,pulmonary consolidation （n=1 ）and tuberculous granuloma （n= 1 ）. Postoperative drainage duration was 1-7 （average 5.04 ± 1 .75 ）days,total drainage volume 50-1500 （average 611 .96 ± 435.24 ）ml,daily drainage volume 18-215 （average 113.44 ± 61 .54 ）ml and postoperative hospital stay 5-17 （mean 8.35 ±3.05 ）days.There was only one case of postoperative pneumonia.No atelectasis,bleeding or bronchial fistula was found.Conclusions VATS with single utility port can accomplish wedge resection,lobectomy and even complex sleeve resection of lung disease in children.Such a method is feasible with satisfactory therapeutic outcomes.

关 键 词：胸腔镜检查 肺叶切除术 预后 

分 类 号：R726.5[医药卫生—儿科]