胸腔镜手术治疗小儿先天性肺气道畸形或肺隔离症合并同侧纵隔支气管源性囊肿7例  

Video-assisted Thoracoscopic Surgery in the Treatment of 7 Children With Pulmonary Airway Malformation or Pulmonary Isolation Complicated With Ipsilateral Mediastinal Bronchogenic Cysts

作　　者：赵华善 翟允鹏[1] 郭锐[1] 白月霞[2] 许洪修 黄赛 沈刚 张士松[1] Zhao Huashan;Zhai Yunpeng;Guo Rui(Department of Surgery of Thoracic Oncology,Children’s Hospital Affiliated to Shandong University,Jinan Children’s Hospital,Jinan 250022,China)

机构地区：[1]山东大学附属儿童医院、济南市儿童医院胸外肿瘤外科,济南250022 [2]山东大学附属儿童医院、济南市儿童医院病理科,济南250022

出　　处：《中国微创外科杂志》2025年第2期92-96,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：2024年济南市卫生健康委员会科技发展计划项目(2024304040)。

摘　　要：目的探讨胸腔镜手术治疗小儿先天性肺气道畸形(congenital pulmonary airway malformation,CPAM)或肺隔离症合并同侧纵隔支气管源性囊肿的可行性。方法2019年7月~2024年7月我们采用胸腔镜手术治疗CPAM或肺隔离症合并支气管源性囊肿7例。侧胸入路三孔法全胸腔镜手术,患儿健侧卧位,观察孔为肩胛下线与第5肋间交点处,操作孔根据手术需要结合腔镜菱形法建立,三孔均使用5 mm trocar。CO_(2)气胸压力4 mm Hg,流量2 L/min,根据患儿术中情况随时调整。手术切口以肺手术为主进行设计,先进行肺部手术,再切除支气管源性囊肿,必要时分块切除以避免气管的严重并发症。结果7例手术均在胸腔镜下完成,无中转开放手术。手术时间37~191 min(中位时间101 min)。术中出血量1~15 ml(中位数5 ml)。1例未留置胸腔闭式引流管,6例留置胸腔闭式引流管留置1~5 d(中位数3 d)。术后病理:CPAM合并支气管源性囊肿5例,其中2型(细支气管型)4例,3型(细支气管/肺泡型)1例,叶外型肺隔离症合并支气管源性囊肿2例。7例随访6~57个月(中位数27个月),胸部CT示均无病变复发。结论小儿CPAM或肺隔离症可能同时合并支气管源性囊肿,术前影像学检查与手术观察相对应,仔细探查,避免漏诊。胸腔镜手术治疗小儿CPAM或肺隔离症合并同侧纵隔支气管源性囊肿安全可行。Objective To explore the feasibility of video-assisted thoracoscopic surgery(VATS)in the treatment of congenital pulmonary airway malformation(CPAM)or pulmonary isolation complicated with ipsilateral mediastinal bronchogenic cyst in children.Methods From July 2019 to July 2024,VATS was carried out to treat CPAM or pulmonary isolation with ipsilateral mediastinal bronchogenic cyst in 7 children.A three-hole thoracoscopic surgery via lateral thoracic approach was performed.The patients were placed in a healthy lateral position.The observation hole was located at the intersection of the subscapular line and the 5th intercostal space,and the operating hole was established according to the surgical requirements in combination with the lumboscopic diamond rule.A 5 mm trocar was used for all three holes.The pressure of CO_(2) pneumothorax was 4 mm Hg and the flow rate was 2 L/min,which was adjusted at any time according to the intraoperative conditions of the children.The operation was mainly designed for lung operation.The pulmonary operation was conducted firstly,and then the bronchogenic cyst was treated.If necessary,block resection was applied to avoid serious complications of trachea.Results All the operations were performed under thoracoscopy without conversion to open surgery.The operation time was 37-191 min(median,101 min).The intraoperative bleeding volume was 1-15 ml(median,5 ml).One case was not given a closed chest drainage tube placed,and the other 6 cases were placed a closed chest drainage for 1-5 d(median,3 d).Postoperative pathology showed 5 cases of CPAM combined with bronchogenic cysts,including 4 cases of type 2(bronchiole type)and 1 case of type 3(bronchiole/alveolar type),and 2 cases of extralobular pulmonary isolation combined with bronchogenic cysts.All the 7 cases were followed up for 6-57 months(median,27 months),and chest CT showed no recurrence of lesions.Conclusions CPAM or pulmonary isolation may be accompanied by bronchogenic cysts.Preoperative imaging examination should correspond to sur

关 键 词：胸腔镜手术 小儿 先天性肺气道畸形 肺隔离症 支气管源性囊肿 

分 类 号：R726.5[医药卫生—儿科]