Messineo A, Fusaro F, Mognato G, Sabatti M, D'Amore E S, Guglielmi M
Pediatric Surgery, Pediatric Institute IRCCS Burlo Garofolo, Trieste, Italy.
Pediatr Pulmonol. 2001 May;31(5):389-93. doi: 10.1002/ppul.1063.abs.
A male infant with a prenatal diagnosis (at 20 weeks' gestation) of cystic adenomatoid malformation was delivered after 38 weeks' gestation (birth weight, 3 kg) and admitted to the neonatal intensive care unit. During the first few days of life, he developed mild respiratory distress; a chest radiograph and computed tomography scan showed multiple cystic areas in the left lower lobe with hyperinflation and herniation of the upper lobe across the midline. At 3 weeks of age, a left lower lobectomy was performed for presumed cystic malformation. To our surprise the pathology reports revealed pulmonary interstitial emphysema. The postoperative chest radiograph was unchanged, and mechanical ventilation was necessary and required progressively increasing ventilatory settings to provide adequate support. High-frequency oscillatory ventilation and selective right bronchus intubation failed to improve lung function. After 3 weeks, a left thoracotomy was repeated and lung volume reduction was performed with removal of 50' of the peripheral hyperinflated parenchyma. Postoperative recovery was rapid; the child was weaned from the ventilator after 3 days and discharged after 3 weeks. Follow-up chest X-rays showed a normally expanded right lung with mediastinal structures back to midline and a small left lung. Favorable results persisted at 3 years of follow-up. This first and successful experience with lung volume reduction in a neonate suggests that infants who need removal of a large portion of lung parenchyma to achieve adequate ventilation and gas exchange, lung volume reduction surgery should be considered as an alternative to pneumonectomy.
一名产前诊断（孕20周）为囊性腺瘤样畸形的男婴在孕38周时出生（出生体重3千克），并入住新生儿重症监护病房。在出生后的头几天，他出现了轻度呼吸窘迫；胸部X光片和计算机断层扫描显示左下叶有多个囊性区域，上叶过度充气并越过中线疝出。3周大时，因推测为囊性畸形而进行了左下叶切除术。令我们惊讶的是，病理报告显示为肺间质肺气肿。术后胸部X光片无变化，需要机械通气，且需要逐渐增加通气设置以提供足够的支持。高频振荡通气和选择性右支气管插管未能改善肺功能。3周后，再次进行左胸切开术并进行肺减容，切除了50%的外周过度充气实质。术后恢复迅速；患儿在3天后脱机，3周后出院。随访胸部X光片显示右肺正常扩张，纵隔结构回到中线，左肺较小。3年随访结果良好。这例新生儿肺减容的首次成功经验表明，对于那些需要切除大部分肺实质以实现充分通气和气体交换的婴儿，肺减容手术应被视为肺切除术的替代方案。
