Sundararajan Lakshmi, Parikh Dakshesh H
Department of Paediatric Surgery, Birmingham Children's Hospital NHS Trust, B4 6NH Birmingham, UK.
J Pediatr Surg. 2007 Jul;42(7):1243-50. doi: 10.1016/j.jpedsurg.2007.02.016.
BACKGROUND/PURPOSE: Video-assisted thoracic surgery (VATS) is increasingly used for the resection of congenital cystic lung lesions (CLLs). This study aimed to evaluate the efficacy of VATS and its outcome in both antenatally and postnatally detected CLLs.
Forty-six patients managed during 2000-2005 were studied. Demographics, investigations, operative details, and outcome data were collected and evaluated. Patients were divided into 3 groups for analysis.
Antenatally diagnosed (groups I and II, n = 35): group I (20) had VATS at 20 months median (range, 16-35 months). Video-assisted thoracic surgery was successful in 14 of 20 (70%), notably in all cases of extralobar sequestrations and foregut duplication cysts. Inadequate vision/lung collapse and technical difficulties were the main reasons for conversion to open thoracotomy. Group II (n = 15) was considered unsuitable for VATS because of neonatal symptoms (6 congenital cystic adenomatoid malformations of the lung [CCAMs]) and/or large size/inexperience (5 CCAMs, 4 sequestrations) and had elective thoracotomy at 8 months median (range, 6 days-20 months). Postnatally diagnosed (group III, n = 11): 3 CCAMs, 6 duplications, and 2 sequestrations were diagnosed because of recurrent chest infection (8) or stridor (2), or incidentally (1) at 8 years median (range, 1.2-14 years). Video-assisted thoracic surgery was successful in 3 foregut duplications. A duplication and an intralobar sequestration were converted; open thoracotomy was performed in others because of previous recurrent pneumonic episodes. Postoperative pain and hospital stay were significantly less (P < .001) in successful VATS resection: median of 2 days (range, 1-7 days) compared with thoracotomy median of 6 days (range, 4-20 days).
Video-assisted thoracic surgery is a safe and effective option for asymptomatic congenital CLLs. It is anticipated that more successful CCAM resections using VATS will occur in the future as our technical ability improves.
背景/目的：电视辅助胸腔镜手术（VATS）越来越多地用于先天性肺囊性病变（CLL）的切除。本研究旨在评估VATS在产前和产后检测到的CLL中的疗效及其结果。
对2000年至2005年期间治疗的46例患者进行研究。收集并评估人口统计学、检查、手术细节和结果数据。患者分为3组进行分析。
产前诊断（I组和II组，n = 35）：I组（20例）在中位年龄20个月（范围16 - 35个月）时接受VATS。20例中有14例（70%）VATS手术成功，特别是在所有肺叶外隔离症和前肠重复囊肿病例中。视野不佳/肺萎陷和技术困难是转为开胸手术的主要原因。II组（n = 15）因新生儿症状（6例先天性肺囊性腺瘤样畸形[CCAM]）和/或囊肿体积大/经验不足（5例CCAM，4例隔离症）被认为不适合VATS，中位年龄8个月（范围6天 - 20个月）时接受择期开胸手术。产后诊断（III组，n = 11）：3例CCAM、6例重复畸形和2例隔离症因反复胸部感染（8例）或喘鸣（2例）或偶然发现（1例）在中位年龄8岁（范围1.2 - 14岁）时被诊断。3例前肠重复畸形VATS手术成功。1例重复畸形和1例肺叶内隔离症转为开胸手术；其他因既往反复肺炎发作而进行开胸手术。成功的VATS切除术后疼痛和住院时间明显缩短（P <.001）：中位时间为2天（范围1 - 7天），而开胸手术中位时间为6天（范围4 - 20天）。
电视辅助胸腔镜手术是无症状先天性CLL的一种安全有效的选择。随着我们技术能力的提高，预计未来使用VATS成功切除CCAM的病例会更多。
