Ponsky Todd A, Rothenberg Steven S
Department of Pediatric Surgery, Case Western Reserve University, Cleveland, Ohio, USA.
J Laparoendosc Adv Surg Tech A. 2008 Feb;18(1):120-2. doi: 10.1089/lap.2007.0161.
Thoracoscopy is replacing open lung biopsies because it is less invasive. However, most surgeons obtain biopsies with an endostapler, which requires a 12-mm trocar and a minimum of 4.5 cm of intrathoracic space to open, making its use in patients less then 10 kg impractical. This report describes the use of the Endoloop (Ethicon Endosurgery, Cincinnati, OH) in small pediatric patients undergoing thoracoscopic lung biopsies.
From 1993 to February 2007, 69 patients underwent thoracoscopic lung biopsy for diagnosis and therapy. Ages ranged from 2 weeks to 4 years and weight from 2 to 22 kg. One 5- and two 3-mm trocars were used in all cases. In all cases, two Endoloops were placed proximal to the segment of lung being biopsied and the lung was divided sharply distal to the Endoloops. The specimen was removed through the 5-mm trocar site. The lung was reexpanded and no chest drains were left in postoperatively.
All 69 procedures were successfully completed thoracoscopically. Two biopsy specimens were obtained, in most cases. Operative time ranged from 10 to 35 minutes (average, 20). There were no intraoperative complications. One patient required reintubation and ventilator support on postoperative day 1 and developed a pneumothorax on postoperative day 2, requiring a chest tube. There were no other complications.
The thoracoscopic approach to lung biopsy is the preferred method of obtaining lung tissue for diagnosis. The use of the Endoloop technique is a safe, effective technique in small pediatric patients, avoiding problems with the limited size of the chest cavity in patients less than 10 kg, and avoids the use of large incisions in a small child.
胸腔镜检查因其侵入性较小，正在取代开放性肺活检。然而，大多数外科医生使用内镜吻合器获取活检样本，这需要一个12毫米的套管针和至少4.5厘米的胸腔内空间来展开操作，使得该方法在体重不足10千克的患者中使用并不实际。本报告描述了Endoloop（美国强生公司爱惜康内镜外科部，俄亥俄州辛辛那提）在小儿胸腔镜肺活检中的应用。
1993年至2007年2月，69例患者接受胸腔镜肺活检以进行诊断和治疗。年龄范围为2周龄至4岁，体重为2至22千克。所有病例均使用一个5毫米和两个3毫米的套管针。在所有病例中，在拟活检的肺段近端放置两个Endoloop，然后在Endoloop远侧锐性切断肺组织。标本通过5毫米的套管针穿刺部位取出。肺复张后，术后不留置胸腔引流管。
所有69例手术均成功通过胸腔镜完成。大多数情况下获取了两份活检标本。手术时间为10至35分钟（平均20分钟）。术中无并发症。1例患者术后第1天需要重新插管和呼吸机支持，术后第2天出现气胸，需要放置胸管。无其他并发症。
胸腔镜肺活检是获取肺组织进行诊断的首选方法。Endoloop技术在小儿患者中是一种安全、有效的技术，避免了体重不足10千克患者胸腔容积有限带来的问题，并且避免了在小儿患者中使用大切口。
