Diamond Ivan R, Herrera Patricio, Langer Jacob C, Kim Peter C W
Division of General Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.
J Pediatr Surg. 2007 Jun;42(6):1057-61. doi: 10.1016/j.jpedsurg.2007.01.043.
The purpose of the study was to compare the outcomes in children undergoing thoracoscopic versus open resection of congenital lung lesions.
Retrospective review of 12 consecutive children (<3 years of age) undergoing thoracoscopic resection of a congenital lung lesion between 2004 and 2005 was performed. Intraoperative and early postoperative results were compared with randomly selected age- and sex-matched (2:1) patients undergoing thoracotomy between 2000 and 2005.
Twelve children underwent thoracoscopic resection and were compared with 24 that underwent thoracotomy. Seventy five percent of the lesions in both groups were congenital cystic adenomatoid malformations. There were no major intraoperative complications. Two thoracoscopic procedures were converted to a thoracotomy. Perioperative outcomes including operative time, length of stay, duration and volume of chest tube drainage, and dose and duration of intravenous opioids were similar for the procedures. However, children undergoing thoracoscopic procedures were less likely (odds ratio = 0.07) to have received adjunctive regional anesthesia. Overall morbidity was 33% thoracoscopic and 25% open (P = .70).
Thoracoscopic resection is a safe and feasible alternative to open resection of congenital lung lesions. Examination of long-term advantages of the thoracoscopic approach such as decreased risk of chest wall deformity and scoliosis and improved cosmesis will require longer follow-up.
本研究旨在比较接受先天性肺病变胸腔镜切除术与开放性切除术的儿童的治疗结果。
对2004年至2005年间连续12例（年龄<3岁）接受先天性肺病变胸腔镜切除术的儿童进行回顾性研究。将术中及术后早期结果与2000年至2005年间随机选取的年龄和性别匹配（2:1）的接受开胸手术的患者进行比较。
12例儿童接受了胸腔镜切除术，并与24例接受开胸手术的儿童进行比较。两组中75%的病变为先天性囊性腺瘤样畸形。术中无重大并发症。2例胸腔镜手术转为开胸手术。两种手术的围手术期结果，包括手术时间、住院时间、胸管引流的持续时间和量以及静脉注射阿片类药物的剂量和持续时间相似。然而，接受胸腔镜手术的儿童接受辅助区域麻醉的可能性较小（优势比=0.07）。总体发病率胸腔镜手术组为33%，开胸手术组为25%（P=0.70）。
胸腔镜切除术是先天性肺病变开放性切除术的一种安全可行的替代方法。对胸腔镜手术长期优势的研究，如降低胸壁畸形和脊柱侧弯的风险以及改善美容效果，需要更长时间的随访。
