腔镜治疗小儿肺隔离症65例

Minimally Invasive Surgery for Children’s Pulmonary Sequestration:Report of 65 Cases

目的总结腔镜治疗各类小儿肺隔离症的经验。方法回顾性分析2017年1月~2019年12月明确诊断并手术治疗的小儿肺隔离症65例资料。产前超声提示异常占位59例。50例术前无明显症状。术前均行胸部及上腹部增强CT及大血管三维重建,59例明确诊断肺隔离症。叶内型隔离肺初期行胸腔镜下肺叶切除术,后期行胸腔镜下肺段切除术;胸腔内叶外型隔离肺行胸腔镜下隔离肺肺叶切除术,腹膜后隔离肺行腹腔镜下隔离肺切除术。结果叶内型34例,叶外型29例,混合型2例。61例行胸腔镜手术,其中1例膈肌内隔离肺中转开胸;4例行腹腔镜隔离肺切除。无严重并发症发生。结论通过产前超声检查、术前完善胸部及上腹部增强CT及血管重建,基本可以明确诊断小儿肺隔离症。叶内型和叶外型均可在腔镜下完成手术。

Objective To summarize the experience of treating various types of pulmonary sequestration in children.Methods Clinical data of 65 children with pulmonary sequestration who were diagnosed and treated surgically from January 2017 to December 2019 were analyzed retrospectively.Prenatal ultrasound revealed abnormal mass in 59 cases.A total of 50 patients had no significant symptoms preoperatively.Preoperative enhanced CT of chest and upper abdomen and three-dimensional reconstruction of great vessels were performed,and pulmonary sequestration was definitely diagnosed in 59 cases.Thoracoscopic lobectomy was performed initially for intralobar isolated lung and later thoracoscopic segmentectomy was performed.Thoracoscopic isolated lobectomy was performed for extralobar isolated lung in the thoracic cavity,and laparoscopic isolated pneumonectomy was performed for retroperitoneal isolated lung.Results There were 34 cases of intralobar type,29 cases of extralobar type and 2 cases of mixed type.There were 61 patients who underwent thoracoscopic surgery,including 1 patient with diaphragmatic isolation lung converted to thoracotomy,while the remaining 4 patients underwent laparoscopic isolation pneumonectomy.No serious complications occurred.Conclusions The diagnosis of pulmonary sequestration in children can be basically confirmed by prenatal ultrasonography,preoperative enhanced CT of chest and upper abdomen and vascular reconstruction.Both intralobar and extralobar types can be operated in the cavity.