节段性切除治疗先天性肺畸形

Segmental resection for the treatment of congenital pulmonary malformations.

作者信息

Bagrodia Naina, Cassel Shannon, Liao Junlin, Pitcher Graeme, Shilyansky Joel

机构信息

Department of Surgery, Division of Pediatric Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.

出版信息

J Pediatr Surg. 2014 Jun;49(6):905-9. doi: 10.1016/j.jpedsurg.2014.01.021. Epub 2014 Feb 4.

DOI:10.1016/j.jpedsurg.2014.01.021

PMID:24888832

Abstract

PURPOSE

The purpose of this study was to compare clinical outcomes of segmental resection to lobectomy as increasing antenatal diagnosis of congenital pulmonary malformations has led to a shift in surgical management.

METHODS

A retrospective institutional review for patients undergoing surgical excision of congenital pulmonary malformations was performed.

RESULTS

Sixty-two patients with congenital pulmonary malformations were reviewed between 2001 and 2012. Forty-five were included for analysis. Malformations were subdivided into two groups, including congenital lobar emphysema (CLE) (n=11, 24%) and intrapulmonary (IP) lesions (n=34, 76%). Nineteen (56%) IP patients underwent segmental resection, and 15 (79%) were performed thoracoscopically without conversion to thoracotomy. None of these patients had recurrent disease. Lobectomy was performed in 11 (100%) CLE and 15 (44%) IP patients, and the majority were by thoracotomy. Median hospital stay was longer for the lobectomy group at 7days when compared to the segmentectomy group at 2days (p<0.001). There was not a difference in complication rate (21% vs. 19%, p=1.000) or in median number of chest tube days (2 vs. 3days, p=0.079) for segmentectomy versus lobectomy patients.

CONCLUSIONS

Segmental resections of congenital pulmonary malformations can be performed safely while conserving healthy lung tissue.

摘要

目的

随着先天性肺畸形产前诊断率的提高，手术治疗方式发生了转变，本研究旨在比较节段性切除与肺叶切除的临床效果。

方法

对接受先天性肺畸形手术切除的患者进行回顾性机构审查。

结果

2001年至2012年间对62例先天性肺畸形患者进行了审查。45例纳入分析。畸形分为两组，包括先天性大叶性肺气肿（CLE）（n = 11，24%）和肺内（IP）病变（n = 34，76%）。19例（56%）IP患者接受了节段性切除，其中15例（79%）通过胸腔镜手术完成，未转为开胸手术。这些患者均无疾病复发。11例（100%）CLE患者和15例（44%）IP患者接受了肺叶切除，大多数通过开胸手术进行。肺叶切除组的中位住院时间为7天，长于节段切除组的2天（p<0.001）。节段切除患者与肺叶切除患者的并发症发生率（21%对19%，p = 1.000）或胸管留置天数中位数（2天对3天，p = 0.079）无差异。