先天性肺囊性瘤样畸形患儿手术前后肺功能的临床分析

Clinical analysis of pulmonary function in children with congenital cystic adenomatoid malformation before and after surgery

目的探讨先天性肺囊性瘤样畸形(CCAM)手术前后肺功能的指标,以指导临床治疗及随访。方法收集2017年10月至2018年6月期间因CCAM在本院小儿胸外科行手术治疗的临床资料14例,对其手术前及术后半年的肺功能进行对比分析。结果14例CCAM患儿均在产前诊断,生后经CT增强确诊并予胸腔镜微创手术治疗。14例患儿中,7例为左侧CCAM,7例为右侧CCAM。其中1例合并胸腔积液,1例合并漏斗胸,2例同时合并胸腔积液及漏斗胸。14例患儿术前肺功能有3例限制性病变,5例阻塞性病变,余6例肺通气功能基本正常。14例患儿术后肺功能有6例阻塞性病变,余8例肺通气功能基本正常。结论CCAM预后良好,手术是治疗的手段之一。由于存在先天性肺发育不良,部分患儿术前肺功能已存在不同程度的异常,手术虽然解除了结构性畸形,但功能性的恢复,短时间仍可能存在各种异常,其中肺功能的恢复仍需进行长期跟踪随访。本项目旨在通过探讨CCAM手术前后肺功能的变化特征,为临床治疗提供经验及依据。

Objective To explore the indicators of pulmonary function of congenital cystic adenomatoid malformation(CCAM)before and after operation,so as to guide the clinical treatment and follow-up.Methods The clinical data of 14 patients who underwent surgical treatment in department of pediatric thoracic surgery of our hospital due to CCAM from October 2017 to June 2018 were collected,and their lung function before and half a year after surgery was compared and analyzed.Results All of the 14 CCAM cases were diagnosed prenatally,confirmed by enhanced CT and treated with minimally invasive thoracoscopic surgery.Among the 14 children,there were 7 cases of left CCAM and 7 cases of right CCAM,including 1 case with pleural effusion,1 case with funnel chest,and 2 cases with both pleural effusion and funnel chest.There were 3 cases of restrictive lesions and 5 cases of obstructive lesions in preoperative pulmonary function of 14 cases,and the remaining 6 cases had basically normal pulmonary ventilation function.There were 6 cases of obstructive lesions in postoperative pulmonary function of 14 cases,and 8 cases of normal pulmonary ventilation function.Conclusions CCAM has a good prognosis and surgery is one of the treatment methods.Due to the existence of congenital pulmonary dysplasia,some of the children have different degrees of abnormalities in preoperative pulmonary function.Although the operation removes the structural deformity,there might still be various abnormalities in a short period of time in functional recovery,among which the recovery of pulmonary function still requires longterm follow-up.The purpose of this project is to provide experiences and basis for clinical treatment through investigating the change characteristics of pulmonary function before and after surgery for CCAM.