胸腔镜解剖性肺段切除治疗儿童先天性肺疾病临床分析

Retrospective Analysis on the Safety and Feasibility of Thoracoscopic Anatomical Segmentectomy in the Treatment of Congenital Lung Malformations

目的探讨儿童胸腔镜解剖性肺段切除的安全性与可行性。方法回顾性分析2014年1月至2018年9月在四川大学华西医院接受儿童胸腔镜肺段切除手术治疗病例的临床资料。结果共收集病例151例,其中男73例,女78例。年龄5月~13岁3月,平均年龄9.8月。所有病例均在胸腔镜下完成手术,无中转开放。平均手术时间66 min,平均出血量5.9 mL,病灶直径范围1.5~9 cm,平均直径4.8 cm。2例患儿术后出现漏气,保留引流管保守观察1周后自行愈合;56例患儿术后出现不同程度的发热,均在术后2~3 d逐渐恢复。所有病例术后无支气管胸膜瘘、出血、肺不张、肺部感染等并发症发生。术后病检提示:先天性肺气道畸形108例,叶内型隔离肺43例。143例患儿获得3月以上随访,8例患儿失访,失访率为5.2%。随访患儿复查胸部CT,均恢复良好,无残留、复发表现。结论儿童胸腔镜解剖性肺段切除作为一种保肺手术具有较高的安全性与可行性,但该术式应在熟练掌握儿童胸腔镜肺叶精准解剖后逐步实施开展。

Objective To investigate the safety and feasibility of thoracoscopic anatomical pulmonary segmentectomy in children with congenital lung malformations. Methods A retrospective review was conducted to analyze clinical data of children thoracoscopic anatomical pulmonary segmentectomy performed in West China Hospital of Sichuan University from Jan. 2014 to Sept. 2018. Results A total of 151 cases were recorded, including 73 males and 78 females. The average age was 9.8 months, ranging from 5 months to 13.3 years. All the patients underwent thoracoscopic surgery without conversion to open. The average operation time was 66 min, the average amount of bleeding was 5.9 mL and the average size was 4.8 cm. Two children had air leakage after the operation, but recovered after one-week tube drainage and conservative observation therapy. 56 children had postoperative fever in varying degrees, which gradually recovered 2-3 d after operation. No postoperative complications occurred such as bronchial fistula, hemorrhage, atelectasis and pulmonary infection. Postoperative pathological results showed that there were 108 cases of congenital pulmonary airway malformation and 43 cases of intralobar pulmonary sequestration. The median follow-up time was chest computed tomography of follow-up showed that all patients recovered well without recurrence. Conclusion On the basis of thoracoscopic meticulous anatomy of lung lobes, Thoracoscopic anatomical segmentectomy in children is safe and feasible as a lung sparing resection.