摘要
目的探讨运用胸腔镜治疗<3个月婴儿先天性肺气道畸形(congenital pulmonary airway malformation,CPAM)的可行性。方法收集2017年3月至2020年7月经胸腔镜治疗的13例CPAM患儿(<3个月婴儿)的临床资料,对其手术治疗及术后恢复情况进行总结分析。其中,男7例,女6例;手术年龄范围为0.67~2.87个月;体重范围为2.5~6.4 kg。12例于孕期发现病变,3例早产。结果所有患儿的手术均在胸腔镜下完成,无中转开胸病例;其中11例行肺叶切除术,2例行肺叶切除+肺不规则切除术。手术时间范围为45~200 min,中位数为115 min;术中出血量范围为5~20 ml,中位数为10 ml。术后引流管留置时间范围为2~10 d,中位数为3 d;术后住院时间范围为4~12 d,中位数为6 d。术后病理学检查结果:1型6例、2型4例、3型2例和4型1例。术后出现漏气1例,延长带管时间后漏气消失,无出血、支气管胸膜瘘、肺不张等术后并发症。随访时间范围为4个月至3年,所有患儿均恢复良好。复查胸部CT均未见残余病灶,可见肺部炎症消散、患侧胸腔无残腔。结论对于有症状的<3个月的CPAM患儿应尽早行手术治疗;随着微创技术和麻醉管理水平的提高,胸腔镜运用于治疗该类患儿是相对安全有效的。
Objective To explore the feasibility of thoracoscopy for congenital pulmonary airway malformation(CPAM)in infants aged under 3 months.Methods From March 2017 to July 2020,clinical data were reviewed for 13 CPAM children aged under 3 months undergoing thoracoscopy.Surgical approaches and postoperative recovery were summarized.There were 7 boys and 6 girls with an operative age of(0.67-2.87)months and body weight ranged from 2.5 to 6.4 kg.Twelve cases revealed pathological changes during pregnancy and three cases were premature.Results All operations were performed under thoracoscope and there was no conversion into thoracotomy.There were lobectomy(n=11)and lobectomy plus irregular lung resection(n=2).The median operative duration was 115(45-200)min,the median volume of intraoperative blood loss 10(5-20)ml,the median postoperative indwelling time of drainage tube 3(2-10)days and the median postoperative hospital stay 6(4-12)days.Postoperative pathological examination indicated that clinical types wereⅠ(n=6),Ⅱ(n=4),Ⅲ(n=2)andⅣ(n=1).One case of postoperative air leakage disappeared after prolonging tubing time.There were no postoperative complications such as bleeding,bronchopleural fistula or atelectasis.During a follow-up period of 4 to 36 months,all patients recovered well.No residual lesions were found on chest computed tomography(CT),pulmonary inflammation dissipated and no residual cavity was found at the affected side.Conclusions Surgery should be performed as early as possible for symptomatic CPAM children aged under 3 months.With the improvement of mini-invasive technology and anesthesia management level,thoracoscopy is relatively safe and effective.
作者
郭锐
翟允鹏
赵华善
许洪修
张士松
Guo Rui;Zhai Yunpeng;Zhao Huashan;Xu Hongxiu;Zhang Shisong(Department of Thoracic&Tumor Surgery,Qilu Children’s Hospital,Shandong University,Jinan 250022,China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2021年第4期304-309,共6页
Chinese Journal of Pediatric Surgery
关键词
胸腔镜
先天性肺气道畸形
肺切除
Thoracoscopes
Congenital pulmonary airway malformation
Pneumonectomy
