摘要
目的探讨使用结扎夹辅助改良"膨胀萎陷法"在胸腔镜下外后基底段(S9+10)切除治疗儿童先天性肺气道畸形(CPAM)中进行段间平面确定的可行性。方法回顾性研究。收集2019年7月至2021年5月山东大学附属儿童医院经胸腔镜进行S9+10切除的12例CPAM患儿的临床资料,其中男7例,女5例;年龄3.50~11.50个月;体质量为6.5~11.5 kg。术中均使用结扎夹辅助改良"膨胀萎陷法"确定段间平面(S9+10处于膨胀状态,余肺处于萎陷状态)后进行S9+10切除,对其手术治疗及术后恢复情况进行总结分析。结果患儿的手术均在胸腔镜下完成,无中转开胸病例。11例患儿成功使用结扎夹辅助改良"膨胀萎陷法"准确判定段间平面后完成肺段切除,其中右S9+10切除8例,左S9+10切除3例。1例患儿在采用结扎夹辅助改良"膨胀萎陷法"判定段间平面过程中,麻醉医师鼓肺至全肺膨胀后手术者需夹闭结扎夹,因操作不够稳定导致结扎夹脱落没有夹住S9+10,出现操作失败,然后改为传统"膨胀萎陷法"进行操作,又误断基底段支气管,被迫行右基底段切除。手术时间为85~205 min,中位数为149 min;术中出血量为5~15 mL,中位数为10 mL。术后引流管留置时间为2~4 d,中位数为3 d;术后住院时间为5~8 d,中位数为6 d。术后病理学检查结果:1型4例,2型6例,3型2例。术后单纯皮下气肿2例,无出血、支气管胸膜瘘、肺不张等术后并发症。随访时间为6~28个月,中位数为15个月,复查患儿胸部CT均未见残余病灶、患侧胸腔无残腔。结论结扎夹辅助改良"膨胀萎陷法"进行段间平面确定适用于胸腔空间狭小的CPAM患儿,且操作简单、有效,在S9+10切除中使用该法相对安全、可行。
Objective To explore the feasibility of using ligation clip-assisted modified"expansion and co-llapse method"to determine the intersegment plane in thoracoscopic resection of the external posterior basal segment(S9+10)in children with congenital pulmonary airway malformation(CPAM).Methods Retrospective study.The clinical data of 12 CPAM children who underwent thoracoscopic S9+10 resection in Children′s Hospital Affiliated to Shandong University from July 2019 to May 2021 were collected and analyzed.There were 7 males and 5 females.The age at operation ranged from 3.50 to 11.50 months.The body weight of patients ranged from 6.5 to 11.5 kg.In all the patients,the ligation clip-assisted modified"expansion and collapse method"was applied during the operation to determine the intersegment plane(S9+10 was in the expansion state and the remaining lungs were in the collapse state)before thoracoscopic S9+10 resection.After S9+10 resection,the surgical treatment and postoperative recovery were summarized and analyzed.Results All the operations were completed under thoracoscopy,and there was no conversion to thoracotomy.In 11 patients,the intersegment plane was accurately determined by the ligation clips-assisted improved"expansion and collapse method",and the S9+10 segment was successfully resected.Of these 11 cases,8 cases had right S9+10 resection and 3 cases had left S9+10 resection.In the process of using the ligation clip-assisted improved"expansion and collapse method"to determine the intersegment plane,the operator needed to clamp the ligation clip after the anesthesiologist expanded the lung completely.Because the operation was not stable enough,the ligation clip fell off and did not clamp S9+10,resulting in operation failure.The operation was changed to the traditional"expansion and collapse method".Besides,the basal segment bronchus was cut off by mistake,so the right basal segment had to be resected.The operation time ranged from 85 to 205 min,with a median of 149 min.Intraoperative bleeding ranged from 5 to 1
作者
郭锐
于宝华
翟允鹏
赵华善
许洪修
吕龙飞
张士松
Guo Rui;Yu Baohua;Zhai Yunpeng;Zhao Huashan;Xu Hongxiu;Lyu Longfei;Zhang Shisong(Department of Thoracic and Tumor Surgery,Children′s Hospital Affiliated to Shandong University(Jinan Children′s Hospital),Jinan 250022,China;Department of Pediatric Surgery,Affiliated Hospital of Jining Medical College,Jining 272000,China)
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2022年第16期1230-1234,共5页
Chinese Journal of Applied Clinical Pediatrics
基金
2022年度济南市卫生健康委员会科技计划项目(2022-1-49)。
关键词
胸腔镜
段间平面
肺段切除
Thoracoscopy
Intersegment plane
Segmentectomy
