Kaneko Kenitiro, Ono Yasuyuki, Tainaka Takahisa, Sumida Wataru, Kawai Yusuke, Ando Hisami
Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan.
Pediatr Surg Int. 2010 Apr;26(4):361-5. doi: 10.1007/s00383-010-2556-y. Epub 2010 Jan 28.
There are still few reports on thoracoscopic lobectomy in neonates. The rate of prenatally diagnosed congenital cystic lung diseases is increasing, and such diseases appear to be a good indication for thoracoscopic lobectomy.
We performed a prospective trial of thoracoscopic lobectomy for all congenital cystic lung diseases in children. Complete thoracoscopic lobectomy was performed by employing carbon dioxide insufflation without single lung ventilation. The results were analyzed, comparing patients with pre- and postnatal diagnoses.
Seven patients were prenatally diagnosed with congenital pulmonary airway malformations (CPAM) between January 2008 and August 2009, and all but one underwent surgery during the neonatal period (prenatal group). Nine patients underwent surgery after infection subsided due to lesions (7 CPAM, 2 intrapulmonary sequestration) postnatally identified by infection presence (median 2 years; range 15 days to 14 years) (postnatal group). The prenatal group showed a significantly lower rate of adhesions, shorter operation time, and smaller volume of blood loss. There were two conversions in the postnatal group. There were two postoperative complications (persistent air leak and phrenic nerve paralysis) in the prenatal group. The esthetic results were good.
Thoracoscopic lobectomy for congenital cystic lung diseases in neonates was practicable, with good esthetic results. Dissection was easier with significantly less blood loss in patients without adhesions, even in neonates. However, this procedure necessitated highly skilled endoscopic maneuvers within a small working space.
关于新生儿胸腔镜肺叶切除术的报道仍然很少。产前诊断的先天性囊性肺疾病的发生率正在上升，此类疾病似乎是胸腔镜肺叶切除术的良好适应证。
我们对所有儿童先天性囊性肺疾病进行了胸腔镜肺叶切除术的前瞻性试验。采用二氧化碳充气且不进行单肺通气的方式进行完全胸腔镜肺叶切除术。对结果进行分析，比较产前和产后诊断的患者。
2008年1月至2009年8月期间，7例患者产前被诊断为先天性肺气道畸形（CPAM），除1例患者外，其余均在新生儿期接受了手术（产前组）。9例患者在因感染发现病变（7例CPAM，2例肺内隔离症）后感染消退后接受了手术（中位年龄2岁；范围15天至14岁）（产后组）。产前组的粘连率显著较低，手术时间较短，失血量较少。产后组有2例中转开胸。产前组有2例术后并发症（持续性漏气和膈神经麻痹）。美容效果良好。
新生儿先天性囊性肺疾病的胸腔镜肺叶切除术是可行的，美容效果良好。即使在新生儿中，对于没有粘连的患者，解剖更容易，失血量明显更少。然而，该手术需要在狭小的工作空间内进行高难度的内镜操作。
