摘要
背景和目的:因为儿童支气管扩张症的发病率和治疗经验的减少,此病的手术治疗并未被广泛讨论,对患儿是否因手术而受益及可影响治疗效果的手术要点尚存在争议,因此,对此进行回顾以评价在儿童支气管扩张症手术治疗的效果。方法:对1991-2002年间进行手术治疗的54例支气管扩张症患儿的记录进行回顾性分析,包括年龄、性别、临床特点、放射学检查。
Background purpose Surgical treatment of childhood bronchiectasis has not been discussed extensively because of decline in prevalence and experience with this disease. It remains controversial as to which children would benefit from surgery and surgical points that may affect the outcome. Therefore, a retrospective series was prepared to e-valuate the results of surgical treatment of bronchiectasis in children. Methods The records of 54 children who underwent surgery for bronchiectasis between 1991 and 2002 were analyzed retrospectively for age; sex; clinical features; radiologic examinations; details of surgery including type of resection, operative morbidity, and mortality; and outcome. Results Fifty-four patients underwent 58 pulmonary resections during the study period. The mean ages at diagnosis of bronchiectasis and at the time of surgery were 7. 80 ± 3. 70 years (range, 1 to 15 years) and 9. 25 ± 3.92 years (range, 1.5 to 17 years), respectively, with amale to female ratio of 5: 4. The causes of bronchiectasis were lung infection (n = 39), hereditary and inborn diseases (n = 14), and foreign body aspiration (n = 1) . Chest X-rays, bronchography (n = 12) or chest computed tomography (n = 43), and ventila-tion-perfusion scintigraphy (n = 13) were used, and pulmonary function tests (n = 21) and bronchoscopy (n = 54) were performed. The types of resections were lobectomy (63%), pneumonectomy (18.5%), lobectomy with segmentectomy (11.1%), segmentectomy (3.7%), and bilobectomy (3. 7% ). Four patients required a second operation. Forty-one patients (76% ) had complete resection, and 13 patients (24% ) had incomplete resection. Intraoperative and postoperative complications were encountered in 4 (7.4%) and 4 patients (7.4%), respectively. The course after surgery was well in 23 (42. 5% ), improved in 23 (42. 5% ), and unchanged or worse in 5 patients (9. 4% ). The mortality rate was 5. 6% . Conclusions The decision for bronchiectasis surgery should be made in cooperation with the chest diseases unit. Anatomic localization of the disease should be mapped clearly by radiologic and scintigraphic investigations. The morbidity and mortality rates of bronchiectasis surgery are within acceptable ranges. Most of the children benefit from surgery, especially when total excision is accomplished. Pneumonectomy is well tolerated in children without increase in morbidity and mortality. Therefore, pneumonectomy may be preferred instead of leaving residual disease when bronchiectasis is unilateral.
