Lisi Gabriele, Lauriti Giuseppe, Cascini Valentina, Lococo Achille, Chiesa Pierluigi Lelli
Ann Ital Chir. 2013 Mar-Apr;84(2):197-200; discussion 200.
Lung suppurative diseases in children are usually responsive to medical treatment or percutaneous drainage. Rarely, pulmonary resection is required for lung abscess in childhood, particularly in presence of co-morbidities. In these cases, a lobectomy is usually performed through an open thoracotomy, with a reported incidence of bronco-pleural fistula up to 9.1% of pediatric series. This consequence is mainly due to the inflammatory condition; however the lack of knowledge of pediatric and thoracic surgeons with this rare condition in childhood can also play a role. In adults with lung cancer, the buttressing of bronchial stump with the additional support of an intercostal muscle (ICM) flap has proved to prevent this complication, as well as to reduce post-operative pain. We report the first pediatric experience of ICM flap used in 2 immunocompetent children requiring lobectomy for suppurative lung conditions. Our preliminary experience confirms the feasibility of protecting the bronchial stump after lobectomy in children, especially in conditions at risk for bronco-pleural fistula development.
儿童肺部化脓性疾病通常对药物治疗或经皮引流有反应。儿童肺脓肿很少需要肺切除，尤其是在存在合并症的情况下。在这些病例中，通常通过开胸手术进行肺叶切除术，据报道小儿系列中支气管胸膜瘘的发生率高达9.1%。这种后果主要是由于炎症状态；然而，小儿外科医生和胸外科医生对儿童期这种罕见疾病缺乏了解也可能起作用。在成年肺癌患者中，用肋间肌（ICM）皮瓣额外支撑支气管残端已被证明可预防这种并发症，并减轻术后疼痛。我们报告了首例在2名免疫功能正常的儿童中使用ICM皮瓣进行肺叶切除治疗化脓性肺部疾病的小儿经验。我们的初步经验证实了在儿童肺叶切除术后保护支气管残端的可行性，尤其是在有发生支气管胸膜瘘风险的情况下。
