Wang Lu-Ming, Cao Jin-Lin, Hu Jian
Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
J Thorac Dis. 2016 Jan;8(1):31-6. doi: 10.3978/j.issn.2072-1439.2016.01.25.
Pulmonary sequestration (PS), a rare congenital anatomic anomaly of the lung, is usually treated through resection by a conventional thoracotomy procedure. The efficacy and safety of video-assisted thoracic surgery (VATS) in PS treatment has seldom been evaluated. To address this research gap, we assessed the efficacy and safety of VATS in the treatment of PS in a large Chinese cohort.
We retrospectively reviewed 58 patients with PS who had undergone surgical resection in our department between January 2003 and April 2014. Of these patients, 42 (72.4%) underwent thoracotomy, and 16 (27.6%) underwent attempted VATS resection. Clinical and demographic data, including patients' age, sex, complaints, sequestration characteristics, approach and procedures, operative time, resection range, blood loss, drainage volume, chest tube duration, hospital stay, and complications were collected, in addition to short-term follow-up data.
Of the 58 participating patients, 55 accepted anatomic lobectomy, 2 accepted wedge resection, and 1 accepted left lower lobectomy combined with lingular segmentectomy. All lesions were located in the lower lobe, with 1-4 aberrant arteries, except one right upper lobe sequestration. Three cases (18.8%) in the VATS group were converted to thoracotomy because of dense adhesion (n=1), hilar fusion (n=1), or bleeding (n=1). No significant differences in operative time, postoperative hospital stay, or perioperative complications were observed between the VATS and thoracotomy groups, although the VATS patients had less blood loss (P=0.032), a greater drainage volume (P=0.001), and a longer chest tube duration (P=0.001) than their thoracotomy counterparts.
VATS is a viable alternative procedure for PS in some patients. Simple sequestration without a thoracic cavity or hilum adhesion is a good indication for VATS resection, particularly for VATS anatomic lobectomy. Thoracic cavity and hilum adhesion remain a challenge for VATS.
肺隔离症（PS）是一种罕见的先天性肺部解剖异常，通常通过传统开胸手术进行切除。电视辅助胸腔镜手术（VATS）治疗PS的有效性和安全性鲜有评估。为填补这一研究空白，我们在一个大型中国队列中评估了VATS治疗PS的有效性和安全性。
我们回顾性分析了2003年1月至2014年4月间在我科接受手术切除的58例PS患者。其中，42例（72.4%）接受了开胸手术，16例（27.6%）尝试进行VATS切除。收集了临床和人口统计学数据，包括患者的年龄、性别、主诉、隔离症特征、手术入路和操作、手术时间、切除范围、失血量、引流量、胸管留置时间、住院时间和并发症，以及短期随访数据。
58例参与患者中，55例行解剖性肺叶切除术，2例行楔形切除术，1例行左下肺叶切除术联合舌段切除术。除1例右上叶隔离症外，所有病变均位于下叶，有1 - 4支异常动脉。VATS组有3例（18.8%）因粘连致密（n = 1）、肺门融合（n = 1）或出血（n = 1）中转开胸。VATS组和开胸组在手术时间、术后住院时间或围手术期并发症方面未观察到显著差异，尽管VATS组患者的失血量较少（P = 0.032），引流量较大（P = 0.001），胸管留置时间较长（P = 0.001）。
对于部分PS患者，VATS是一种可行的替代手术。无胸腔或肺门粘连的单纯隔离症是VATS切除的良好适应证，尤其是VATS解剖性肺叶切除术。胸腔和肺门粘连仍是VATS面临的挑战。
