Conforti Andrea, Aloi Ivan, Trucchi Alessandro, Morini Francesco, Nahom Antonella, Inserra Alessandro, Bagolan Pietro
Department of Medical and Surgical Neonatology, Unit of Newborn Surgery, Bambino Gesu Children's Hospital, Rome, Italy.
J Thorac Cardiovasc Surg. 2009 Oct;138(4):826-30. doi: 10.1016/j.jtcvs.2009.01.014. Epub 2009 Mar 26.
The optimal management of congenital adenomatoid malformation of the lung remains controversial. Prenatal ultrasonographic analysis has increasingly discovered asymptomatic lesions, raising questions about the need for and timing of surgical treatment for asymptomatic congenital adenomatoid malformation. The aim of our study was to analyze the short-term postoperative outcome of symptomatic congenital adenomatoid malformations compared with asymptomatic malformations.
All the data of patients presenting with congenital adenomatoid malformations histologically diagnosed and operated on between 1998 and 2005 at our institution were retrospectively reviewed. Patients were divided into 2 groups: group A comprised asymptomatic infants, and group B comprised symptomatic infants. Major outcomes considered were the length of ventilation, pleural drainage, and hospital stay. Postoperative morbidity and mortality were also evaluated. Asymptomatic patients were further stratified for age at the time of the operation to evaluate whether age at surgical intervention affects the outcome. The Fisher's exact and Mann-Whitney tests were used as appropriate.
Fifty-seven patients were consecutively treated. Thirty-five patients were given diagnoses of asymptomatic lesions and were enrolled into group A, whereas 22 patients presenting with symptoms were entered into group B. The lengths of ventilation, pleural drainage, and hospital stay were significantly longer in patients with symptomatic congenital adenomatoid malformations. Moreover, symptomatic patients presented with a higher postoperative complication rate. The age-based stratification of asymptomatic children did not show any difference on either postoperative mortality or major outcome considered.
Children with congenital adenomatoid malformations operated on when asymptomatic present a better short-term outcome than symptomatic children. In addition, age at the time of the operation does not negatively affect the outcome. Our findings support early surgical treatment for asymptomatic congenital adenomatoid malformation.
肺先天性腺瘤样畸形的最佳治疗方案仍存在争议。产前超声检查越来越多地发现无症状病变，这引发了对于无症状先天性腺瘤样畸形手术治疗的必要性和时机的疑问。我们研究的目的是分析有症状的先天性腺瘤样畸形与无症状畸形相比的术后短期结局。
回顾性分析1998年至2005年在我院接受组织学诊断并手术治疗的先天性腺瘤样畸形患者的所有数据。患者分为两组：A组为无症状婴儿，B组为有症状婴儿。主要观察指标为通气时间、胸腔引流时间和住院时间。还评估了术后发病率和死亡率。对无症状患者按手术时的年龄进一步分层，以评估手术干预时的年龄是否影响结局。适当使用Fisher精确检验和Mann-Whitney检验。
连续治疗57例患者。35例患者被诊断为无症状病变，纳入A组，而22例有症状的患者进入B组。有症状的先天性腺瘤样畸形患者的通气时间、胸腔引流时间和住院时间明显更长。此外，有症状的患者术后并发症发生率更高。无症状儿童按年龄分层在术后死亡率或所考虑的主要结局方面均未显示出任何差异。
无症状时接受手术治疗的先天性腺瘤样畸形儿童的短期结局比有症状的儿童更好。此外，手术时的年龄不会对结局产生负面影响。我们的研究结果支持对无症状先天性腺瘤样畸形进行早期手术治疗。
