胸腔镜手术治疗婴幼儿先天性肺气道畸形术后免胸管留置的初步研究  

Primary Study of Video-assisted Thoracoscopic Surgery Without Chest Tube Drainage for Infants With Congenital Pulmonary Airway Malformation

作　　者：李潇[1] 蔡纯 周槟 娄蕾 沈玲会 张刚 周晓彤 俞钢 Li Xiao;Cai Chun;Zhou Bin(Department of Pediatric Surgery,Third Affiliated Hospital of Guangzhou Medical University,Guangdong Provincial Key Laboratory of Major Obstetric Diseases,Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology,Guangzhou 510150,China)

机构地区：[1]广州医科大学附属第三医院小儿外科、广东省产科重大疾病重点实验室、广东省妇产疾病临床医学研究中心,广州510150

出　　处：《中国微创外科杂志》2025年第2期65-69,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨胸腔镜手术治疗婴幼儿先天性肺气道畸形(congenital pulmonary airway malformation,CPAM)免胸管留置的可行性和安全性。方法回顾分析我科2019年5月~2022年8月胸腔镜手术治疗145例婴幼儿CDAM的临床资料,其中6例手术结束时留置胸管,139例患儿手术结束时不留置胸管,肺段切除99例,肺叶切除36例,肺叶合并肺段切除4例,观察临床疗效及术后并发症。结果145例行胸腔镜手术,无中转开胸,无围手术期死亡。6例手术结束时留置胸管,余139例患儿手术结束时不留置胸管。手术时间(42.0±16.6)min,术中出血量(2.7±2.0)ml。术后因气胸或胸腔积液置入胸管患儿6例,置入率4.3%;余133例患儿常规术后第3天复查胸部X线片,其中8例术侧轻度气胸(肺压缩<20%)均不需要进一步处理,出院前复查胸片,气胸均基本吸收。所有患儿均顺利康复出院,住院时间(6.6±1.3)d。结论胸腔镜治疗婴幼儿CPAM术后不置胸管对选择性患儿是安全、可行的。Objective To evaluate the technical feasibility and safety of video-assisted thoracoscopic surgery(VATS)without chest tube placement for infants with congenital pulmonary airway malformation(CPAM).Methods Clinical data of 145 infants with CPAM treated by VATS from May 2019 to August 2022 were retrospectively analyzed.Six cases had a chest tube placement at the end of the surgery,while 139 cases did not.Among them,there were 99 segmental lobectomies,36 lobectomies,and 4 lobectomies and segmental lobectomies.Clinical efficacy and postoperative complications were observed.Results All the 145 patients underwent resection by VATS without conversion to thoracotomy.There was no mortality during the perioperative period.In the 139 cases without chest tube placement at the end of surgery,the operation time was(42.0±16.6)min,and the intraoperative blood loss was(2.7±2.0)ml.The were 6 cases who were given indwelling drainage tube for pneumothorax or pleural effusion after surgery,the rate of re-catheterization being 4.3%.The remaining 133 cases had chest X-ray review on the third day after routine surgery.Among them,8 cases had mild pneumothorax(lung compression<20%)on the surgical side,which did not require further treatment.Before discharge,chest X-ray re-examination showed that pneumothorax was basically absorbed.All the patients were discharged with uneventful recovery,and the hospital stay was(6.6±1.3)d.Conclusion VATS without chest tube placement is a safe and feasible surgical procedure for some selective infants with congenital pulmonary airway malformation.

关 键 词：胸腔镜手术 先天性肺气道畸形 胸管 胸腔引流 

分 类 号：R726.5[医药卫生—儿科]