儿童胸腔镜精准肺叶切除术128例报道

Clinical Report of 128 Cases of Meticulous Thoracoscopic Lobectomy in Children

目的探讨儿童肺部病灶行胸腔镜精准肺叶切除的可行性及效果。方法回顾性分析2013年10月至2017年3月于四川大学华西医院接受胸腔镜精准肺叶切除的儿童患者的临床资料。结果本组共128例患儿,其中男69例,女59例;术前诊断为先天性肺囊肿62例,囊性腺瘤样畸形47例,隔离肺17例,肺部肿瘤2例;病灶位于肺上叶28例,下叶98例,中叶2例。术中均对肺叶动静脉、支气管及叶间裂组织进行精准处理。除1例因反复感染胸腔粘连严重而转开放外,其余患儿均在腔镜下顺利完成手术,术中出血3~5 mL,手术时间35~120min,平均55min。34例近期手术患儿术毕未安置胸腔闭式引流管,其余患儿均在术后24h内拔除胸腔闭式引流管,无肺不张、出血、支气管胸膜瘘、肺部感染等并发症发生,术后3~4d出院。术后随访6~36月,所有病例均恢复良好,无复发病例。结论胸腔镜精准肺叶切除在儿童病例中有较好的可行性,且通过对各主要结构的精准处理,能有效避免各类常见术后并发症的发生,加快患儿恢复,缩短住院时间,值得推广应用。

Objective To investigate the feasibility and effect of precise thoracoscopic lobectomy in children.Methods The clinical data of precise thoracoscopic lobectomy in infants and children were analyzed retrospectively in West China Hospital of Sichuan University.Results There were total 128 cases（male 69,female 59）of precise thoracoscopic lobectomy in infants and children from Oct,2013 to March,2017,which including 62 cases of congenital cyst of lungs,47 cases of cystic adenomatoid malformations,17 cases of pulmonary sequestrations,and 2 cases of lung tumors.The lesions cvere located in upper lobe of lung in 28 cases,lower lobe in 98 cases and middle lobe in 2 cases.Intraoperative pulmonary arteriovenous,bronchial and interlobar fissure tissues were precisely treated.One case was converted to open surgery because of the thoracic adhesions due to repeated infection,the remaining cases were successfully completed under the endoscopic procedure.Intraoperative bleeding was 3-5 mL,operation time was 35-120 min,mean 55 min.The closed thoracic drainage tubes were removed within 24 h postoperatively;No atelectasis,bleeding,bronchial pleural fistula,pulmonary infection and other complications occurred.The post-operative hospital day ranged 3-4 d.During the follow-up for 6-36 months,all cases were recovered well,and no recurrence occurred.Conclusion Meticulous thoracoscopic lobectomy is feasible in children,and it is effective in avoiding common postoperative complications,accelerating the recovery and shortening the hospitalization time.