Sacks Greg D, Chung Katherine, Jamil Kevin, Garg Meena, Dunn James C Y, DeUgarte Daniel A
Division of Pediatric Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, P. O. Box 709818, Los Angeles, CA, 90095-7098, USA.
Pediatr Surg Int. 2014 May;30(5):573-6. doi: 10.1007/s00383-014-3482-1. Epub 2014 Feb 14.
Acquired neonatal lung lesions including pneumatoceles, cystic bronchopulmonary dysplasia, and pulmonary interstitial emphysema can cause extrinsic mediastinal compression, which may impair pulmonary and cardiac function. Acquired lung lesions are typically managed medically. Here we report a case series of three extremely premature infants with acquired lung lesions. All three patients underwent aggressive medical management and ultimately required tube thoracostomies. These interventions were unsuccessful and emergency thoracotomies were performed in each case. Two infants with acquired pneumatoceles underwent unroofing of the cystic structure and primary repair of a bronchial defect. The third infant with pulmonary interstitial emphysema, arising from cystic bronchopulmonary dysplasia, required a middle lobectomy for severe and diffuse cystic disease. When medical management fails, tube thoracostomy can be attempted, leaving surgical intervention for refractory cases. Surgical options include oversewing a bronchial defect in the setting of a bronchopleural fistula or lung resection in cases of an isolated expanding lobe.
获得性新生儿肺部病变，包括肺气囊、囊性支气管肺发育不良和肺间质肺气肿，可导致纵隔外压，这可能损害肺和心脏功能。获得性肺部病变通常采用药物治疗。在此，我们报告一组三例患有获得性肺部病变的极早产儿病例系列。所有三名患者均接受了积极的药物治疗，最终均需要进行胸腔闭式引流术。这些干预措施均未成功，随后对每例患者均进行了急诊开胸手术。两名患有获得性肺气囊的婴儿接受了囊性结构的去顶术和支气管缺损的一期修复。第三名患有因囊性支气管肺发育不良引起的肺间质肺气肿的婴儿，因严重弥漫性囊性疾病需要进行中叶切除术。当药物治疗失败时，可以尝试进行胸腔闭式引流术，对于难治性病例则进行手术干预。手术选择包括在支气管胸膜瘘的情况下缝合支气管缺损，或在孤立性扩张肺叶的情况下进行肺切除术。
