全胸腔镜解剖性肺段切除术治疗儿童先天性肺气道畸形的经验体会  

Retrospective analysis of total thoracoscopic anatomical segmentectomy for treatment of congenital pulmonary airway malformations in children

作　　者：王元祥[1] 提运幸[1] 黄骏荣 郑丰楠 孟保英[1] 张青[1] 丁以群[1] Wang Yuanxiang;Ti Yunxing;Huang Junrong;Zheng Fengnan;Meng Baoying;Zhang Qing;Ding Yiqun(Department of Cardiothoracic Surgery,Shenzhen Children’s Hospital,Shenzhen 518038,China)

机构地区：[1]深圳市儿童医院胸心外科,深圳518038

出　　处：《中华小儿外科杂志》2021年第4期299-303,共5页Chinese Journal of Pediatric Surgery

基　　金：深圳市卫生计划系统科研项目(SZXJ2018044);深圳市医疗卫生三名工程项目(SZSM201612003);深圳市医学重点学科建设经费资助(SZXK036)。

摘　　要：目的探讨运用全胸腔镜解剖性肺段切除术治疗儿童先天性肺气道畸形(congenital pulmonary airway malformation,CPAM)的经验和体会。方法回顾性分析2017年11月至2020年6月在深圳市儿童医院行全胸腔镜解剖性肺段切除术的24例CPAM患儿围手术期的临床资料。其中,男13例,女11例,年龄范围为5~70个月,年龄为(23.3±18.3)个月,体重为(11.0±2.5)kg。胸腔镜采用3孔法,根据病变情况选择单肺段切除或联合肺段切除。结果所有患儿中22例成功完成全胸腔镜解剖性肺段切除术,2例中转行肺叶切除术,无中转开胸;22例中,单肺段切除7例,联合肺段切除15例;术后无严重并发症,所有患儿无院内死亡。22例完成全胸腔镜解剖性肺段切除术患儿的手术时间为(182.6±42.9)min,术中出血量为(21.0±52.4)ml,ICU滞留时间为(17.6±2.8)h,术后胸管留置时间为(3.5±1.1)d,术后住院时间为(6.0±1.7)d。术后病理学检查结果证实均为CPAM,其中合并隔离肺3例。术后随访时间为(13.3±8.9)个月,因迟发性气胸再入院1例,无复发及再手术病例。结论在掌握肺叶切除技巧、熟悉肺段解剖、结合增强CT三维重建辅助研判的基础上运用全胸腔镜解剖性肺段切除术治疗CPAM是安全、可行的。Objective To summarize the therapeutic experiences of total thoracoscopic anatomical segmentectomy for congenital pulmonary airway malformations in children.Methods Perioperative clinical data were retrospectively analyzed for 24 children with congenital pulmonary airway malformation undergoing thoracoscopic anatomical segmentectomy from November 2017 to June 2020.There were 13 boys and 11 girls with an age range of(23.3±18.3)months and an average body weight of(11.0±2.5)kg.Using three-port thoracoscopic technique,single segment resection or combined segmental resection was performed according to actual situations.Results Thoracoscopic anatomical segmentectomy was performed successfully in 22 cases,including single segment resection(n=7)and combined segmental resection(n=15).Two cases were switched to anatomical lobectomies while there was no conversion into thoracotomy.Neither severe complications nor hospital mortality occurred.The average operative duration was(182.6±42.9)min,volume of intraoperative bleeding(21.0±52.4)ml,average ICU duration(17.6±2.8)hours and indwelling length of drainage tube(3.5±1.1)days postoperatively.The length of postoperative hospital stay was(6.0±1.7)days.All were confirmed by pathological examination as congenital pulmonary airway malformations.Three cases were complicated with pulmonary sequestration.During a follow-up period of(13.3±8.9)months,1 case was re-admitted due to delayed pneumothorax.There was no instance of reoperation.Conclusions Based upon skilled thoracoscopic lobectomy technique,familiarity with lung anatomy and diagnosis of enhanced three-dimensional CT reconstruction,thoracoscopic anatomical segmentectomy is feasible and safe for congenital pulmonary airway malformations in children.

关 键 词：胸腔镜 先天性肺气道畸形 解剖性肺段切除 儿童 

分 类 号：R726.5[医药卫生—儿科]