Clermidi Pauline, Bellon Myriam, Skhiri Alia, Jaby Olivier, Vitoux Christine, Peuchmaur Michel, Bonnard Arnaud
Department of Pediatric Surgery, Robert Debré Hospital, AP-HP 48 boulevard Sérurier, 75019 Paris, France.
Department of Pediatric Anesthesiology, Robert Debré Hospital, AP-HP 48 boulevard Sérurier, 75019 Paris, France.
J Pediatr Surg. 2017 Nov;52(11):1800-1805. doi: 10.1016/j.jpedsurg.2017.02.005. Epub 2017 Feb 16.
Thoracoscopic lung resection for congenital pulmonary airway malformation (CPAM) is a safe technique for children. Our purpose was to evaluate the feasibility of a fast-track protocol in such cases.
From September 2007 to May 2016, 101 patients underwent a thoracoscopic pulmonary resection of which 83 for CPAM (lobectomy, wedge resection or sequestrectomy). We retrospectively reviewed the characteristics of surgical procedure, postoperative management and complications through three time periods (September 2007-December 2009: n=14, January 2010-March 2013: n=30, April 2013-May 2016: n=39) corresponding to management protocols modifications introducing fast-track pathways.
Through the 3 time periods, median postoperative hospital stay decreases (4, 3, 2days successively, P=0.02). In the third time period, 4 patients underwent surgery in day-case surgery. The overall and surgical complication rates, mainly related to air leakage, remain stable through the 3 time periods (14%, P=0.41 and 10%, P=0.52 respectively). Among the 13 patients without postoperative pleural drainage, one required secondary drainage after a partial resection of an emphysema.
Fast-track protocol for children undergoing uncomplicated thoracic surgery for CPAM seems feasible without extra morbidity. Selected patient undergoing thoracoscopic resection of the lung may benefit from the absence of pleural drainage and can be operated on in day-case surgery.
Level III.
胸腔镜肺切除术治疗先天性肺气道畸形（CPAM）对儿童来说是一种安全的技术。我们的目的是评估在此类病例中实施快速康复方案的可行性。
2007年9月至2016年5月，101例患者接受了胸腔镜肺切除术，其中83例为CPAM（肺叶切除术、楔形切除术或肺隔离症切除术）。我们回顾性分析了三个时间段（2007年9月至2009年12月：n = 14，2010年1月至2013年3月：n = 30，2013年4月至2016年5月：n = 39）的手术过程特点、术后管理及并发症情况，这三个时间段对应着引入快速康复路径的管理方案调整。
在这三个时间段中，术后中位住院时间逐渐缩短（依次为4天、3天、2天，P = 0.02）。在第三个时间段，有4例患者接受了日间手术。总体并发症率和手术并发症率在三个时间段内保持稳定，主要与漏气相关（分别为14%，P = 0.41和10%，P = 0.52）。在13例未进行术后胸腔引流的患者中，1例在肺气肿部分切除术后需要二次引流。
对于接受CPAM简单胸科手术的儿童，快速康复方案似乎可行且不会增加额外发病率。部分接受胸腔镜肺切除术的患者可能受益于无需胸腔引流，并且可以进行日间手术。
三级。
