腔镜手术治疗肺隔离症患儿47例

Endoscopic lobectomy for 47 children with pulmonary sequestration

目的:探讨腔镜手术治疗肺隔离症患儿的可行性。方法:回顾性分析浙江大学医学院附属儿童医院2015年4月至2017年11月诊治的47例肺隔离症患儿的临床资料。根据手术开展时间,将2015年4月至2016年12月手术的19例患儿归为前期手术组,2017年1月至2017年11月手术的23例患儿归为后期手术组(5例膈肌内肺隔离症患儿由于类型特殊未参与分组)。比较前期手术组和后期手术组手术时间、术中出血量、术后引流管留置天数、术后住院天数和术后并发症的发生率等指标。结果:47例患儿中,2例中转开胸,其余45例患儿均顺利完成腔镜手术,无手术死亡。后期手术组手术时间较前期手术组缩短(P<0.05),术中出血量较前期手术组减少(P<0.05),但引流管留置天数和术后住院天数与前期手术组差异无统计学意义(均P>0.05)。14例患儿发生术后并发症(气胸4例、胸腔积液8例,肺部感染1例,膈疝1例),其中后期手术组术后并发症的发生率为17.4%(4/23),较前期手术组(8/19,42.1%)降低,但差异无统计学意义(P>0.05)。术后随访2~26个月,所有患儿无复发及胸廓塌陷,剩余肺代偿良好。结论:腔镜手术治疗肺隔离症患儿创伤小,出血少,术后恢复快,安全可行。

Objective： To evaluate the feasibility of endoscopic lobectomy for pulmonary sequestration in children. Methods： Clinical data of 47 children with pulmonary sequestration treated with endoscopic lobectomy from April 2015 to November2017 were reviewed. According to the operation date,19 children received operation from April 2015 to December 2016 were early group,and 23 children received operation from January 2017 to November 2017 were late group（ 5 children with lesions inside diaphragm were excluded）. The operation time,intraoperative blood loss,retention time of drainage tube,length of hospital stay and incidence of complications were compared between two groups. Results： Among 47 children,endoscopic lobectomy was successfully completed in 45 children, and the rest 2 children were converted to thoracotomy. No death was observed. The operation time in late group was shorter than that in the early group（ P〈0. 05）,and the intraoperative blood loss of the late group was less than that of early group（ P〈0. 05）; while there were no significant differences in retention time of drainage tube and length of hospital stay between two groups（ both P〉0. 05）. Postoperative complications occurred in 14 children,including 4 cases of pneumothorax,8 cases of pleural effusion,1 case of pulmonary infection,and 1 case of diaphragmatic hernia. The incidence rates of postoperative complications in late group and early group were 17. 4%（ 4/23） and 42. 1%（ 8/19）,and the difference was not statistically significant（ P〉0. 05）. During the follow-up（ 2-26 months）,no relapse and thoracic collapes were observed,and CT examination found that the remaining lungs were well compensated in all children. Conclusion： The endoscopic lobectomy is effective and safe with less trauma and bleeding,which is recommended for treatment of pulmonary sequestration in children.