雾化吸入吲哚菁绿在胸腔镜儿童先天性肺畸形手术中的应用  

Application of inhalational indocyanine green during thoracoscopy for congenital lung malformations in children

作　　者：贺颖 曹鹏 尹晔 颛孙迪迪 刘率斌 蒙信尧 王文静 熊晓峰[1] 朱天琦 冯杰雄[1] He Ying;Cao Peng;Yin Ye;Zhuansun Didi;Liu Shuaibin;Meng Xinyao;Wang Wenjing;Xiong Xiaofeng;Zhu Tianqi;Feng Jiexiong(Department of Pediatric Surgery,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院小儿外科,武汉430030

出　　处：《中华小儿外科杂志》2024年第11期985-991,共7页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨在儿童先天性肺畸形治疗中应用术前雾化吸入吲哚菁绿(indocyanine green, ICG)实现胸腔镜下先天性肺畸形精准切除的可行性。方法分析2023年1月至2023年5月在华中科技大同济医学院附属同济医院小儿外科住院手术治疗的先天性肺畸形患儿27例, 17例雾化吸入吲哚菁绿患儿为ICG组, 另外10例传统胸腔镜手术患儿为传统组。先天性肺气道畸形20例, 叶内型肺隔离症7例, 其中双侧多发先天性肺气道畸形1例, 行分期手术切除病变。ICG组患儿术前采用雾化吸入ICG溶液(0.5 mg/kg), 术中使用荧光胸腔镜显影并精准切除病灶。传统组患儿未行ICG雾化吸入, 采用传统肺段或肺叶切除术。统计并对比两组手术时间、术中出血、术后胸腔闭式引流时间、术后住院时间。出院后跟踪随访, 采用配对秩和检验对比并分析术前及术后胸部CT及肺功能检测指标, 包括公斤潮气量(tidal volume per kilogram, VT/kg)、分钟通气量(minute ventilation volume, MV)、潮气呼吸呼气峰流速量(peak tidal expiratory flow, PTEF)、呼吸达峰时间比(ratio of time to peak tidal expiratory flow to total expiratory time, TPTEF/TE)、达峰容积比(ratio of volume at peak tidal expiratory flow to expiratory tidal volume, VPEF/VE)。结果 27例患儿均顺利完成手术康复出院, 无死亡病例, 无患儿出现不良反应。两组在手术时间[(100.3±24.6)min比(74.8±17.7)min]和术后胸腔闭式引流时间[(48.5±24.3)h比(83.0±17.1)h]方面差异有统计学意义(均P<0.01), 在术中出血和术后住院时间方面差异无统计学意义(P>0.01), 所有患儿术后3~6个月完成随访, 随访率100%。两组随访均无病灶残留或复发, 对比肺功能检测结果, ICG组手术前后TPTEF/TE、VPEF/VE、VT/kg、MV差异有统计学意义(均P<0.01)。ICG组与传统组术前术后相关肺功能指标对比, TPTEF/TE、VT/kg、MV、PTEF差异均具有统计学意义(均P<0.05)。结论雾化吸入Objective:To explore the effectiveness and feasibility of preoperative aerosol inhalation of indocyanine green(ICG)solution for thoracoscopic resection of congenital lung malformations(CLM)in children.Methods:From January 2023 to May 2023,the relevant clinical data were retrospectively reviewed for 27 CLM children.They were assigned into two groups of aerosolized indocyanine green(ICG,n=17)and traditional thoracoscopy(n=10).There were congenital cystic adenomatous malformations(n=20)and intralobar pulmonary sequestration(n=7).One case with bilateral multiple congenital cystic adenomatous malformations underwent 2-staged operation.ICG group received a preoperative atomized inhalation of ICG solution(0.5 mg/kg).Fluorescent thoracoscopic imaging was utilized intraoperatively for precisely resecting lesion.Traditional group underwent segment resections or lobectomy without an inhalation of ICG.Operative duration,intraoperative volume of blood loss,postoperative indwelling time of closed chest drainage tube and postoperative length of stay of two groups were recorded.Post-discharge follow-ups were conducted.And perioperative chest computed tomography(CT)findings and pulmonary function test parameters of kilogram tidal volume per kilogram(vt/kg),minute ventilation volume(MV),peak tidal expiratory flow(PTEF),ratio of time to peak tidal expiratory flow to total expiratory time(TPTEF/TE)and ratio of volume at peak tidal expiratory flow to expiratory tidal volume(VPEF/VE)were also recorded.Results:All of them were discharged from hospital after a full recovery.There was no mortality or adverse reactions.Significant inter-group differences existed in operative duration[(100.3±24.6)min vs.(74.8±17.7)min]and postoperative indwelling time of closed chest drainage tube[(48.5±24.3)h vs.(83.0±17.1)h](P<0.01),However,no significant difference existed in intraoperative volume of blood loss or postoperative length of hospitalization(P>0.01).The postoperative follow-up period was(3-6)month.There was no residual or recurrence of l

关 键 词：胸腔镜 肺切除术 吸入给药 吲哚菁绿 

分 类 号：R726.5[医药卫生—儿科]