Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany.
World J Pediatr. 2012 Aug;8(3):272-4. doi: 10.1007/s12519-011-0283-7. Epub 2011 Aug 27.
The size of congenital pulmonary malformation (CPM) in infants might interfere with the feasibility of thoracoscopic resection. This study was undertaken to evaluate the impact of the size of CPM on the applicability of video-assisted thoracic surgery (VATS) in infants.
Twenty-two infants were operated on for CPM from November 2000 to June 2009. The intra- and postoperative course was analyzed retrospectively from patient charts. Preoperative scans were evaluated blindly by a radiologist to calculate the relation between the maximum size of the lesion and the thoracic diameter in VATS and open procedures.
VATS was performed in 14 (64%) of the 22 patients and thoracotomy in 8. VATS was successfully performed in 11 (79%) of the 14 patients, whereas VATS was converted to thoracotomy due to lack of overview in 3 (21%). The mean relative size of CPM at preoperative imaging was 0.34 ± 0.05 (range: 0.3-0.4) in patients who received successful VATS, 0.57 ± 0.06 (range: 0.5-0.6) in converted cases, and 0.68 ± 0.10 (range: 0.5-0.8) in infants who underwent thoracotomy. The relative CPM size was significantly lower in successful VATS than in cases of conversion (P<0.01) and thoracotomy (P<0.01).
The relative size of CPM at preoperative imaging might be useful information for a decision-making on the use of VATS in infants. A relative CPM size below 0.5, which is less than half of the thoracic diameter, indicates a good feasibility for thoracoscopic resection of CPM. A larger size may indicate that VATS might be technically difficult.
婴儿先天性肺畸形（CPM）的大小可能会影响胸腔镜切除的可行性。本研究旨在评估 CPM 大小对婴儿胸腔镜手术（VATS）适用性的影响。
2000 年 11 月至 2009 年 6 月，对 22 例 CPM 婴儿进行手术。回顾性分析患者病历中的围手术期资料。由一名放射科医生对术前扫描进行盲法评估，以计算 VATS 和开胸手术中病变最大尺寸与胸腔直径的关系。
22 例患者中 14 例行 VATS（64%），8 例行开胸手术。14 例患者中 VATS 成功完成 11 例（79%），3 例（21%）因缺乏全景而转为开胸手术。VATS 成功组术前影像学 CPM 的相对大小为 0.34 ± 0.05（范围：0.3-0.4），转换组为 0.57 ± 0.06（范围：0.5-0.6），开胸组为 0.68 ± 0.10（范围：0.5-0.8）。VATS 成功组的相对 CPM 大小明显低于转换组（P<0.01）和开胸组（P<0.01）。
术前影像学 CPM 的相对大小可能是决定婴儿是否采用 VATS 的有用信息。相对 CPM 大小低于 0.5（小于胸腔直径的一半），提示胸腔镜切除 CPM 的可行性良好。较大的尺寸可能表明 VATS 可能具有技术难度。
