Bolaños-Morales Francina V, Gómez-Portugal Emmanuel Peña, Aguilar-Mena María E, Santillán-Doherty Patricio J, Sotres-Vega Avelina, Santibáñez-Salgado J Alfredo
Department of Cardiothoracic Surgery, National Institute of Respiratory Diseases "Ismael Cosio Villegas", México DF, Mexico.
INER, Calzada de Tlalpan 4502, Col. Sección XVI., Tlalpan, 14080, México DF, Mexico.
Gen Thorac Cardiovasc Surg. 2018 Mar;66(3):155-160. doi: 10.1007/s11748-017-0862-1. Epub 2017 Nov 20.
Necrotizing pneumonia is the consolidation of lung parenchyma with destruction and necrosis, forming solitary or multiloculated radiolucent foci. When antibiotic treatment fails and clinical course does not improve, patients might need lung tissue resection: segmentectomy, lobectomy or bilobectomy. We have performed a more conservative surgical approach in pediatric patients with necrotizing pneumonia, lung necrosectomy: resection of unviable necrotic tissue, to preserve more healthy and potentially recoverable lung parenchyma. The objective of this study is to present the results of our experience with lung necrosectomy.
Retrospective review of clinical charts of children with necrotizing pneumonia. The diagnosis was based on physical examination, laboratory data and contrast CT scan. Lung necrosectomy technique includes resection of necrotic tissue with careful debridement technique; air leaks were sutured and/or tissue imbrication.
Twenty-four children were surgically treated for necrotizing pneumonia (18 girls and 6 boys). The mean age was 31.5 ± 13.5 months. All the patients presented productive cough, fever and dyspnea; chest X-rays showed consolidated areas with intraparenchymal cavities and hypoperfusion on the contrasted CT. Surgical treatment included: Lung necrosectomy 17 (70%); lobectomy 3 (12.5%); wedge resection 2 (8.3%); lobectomy + lung necrosectomy 1 (4.1%), and wedge resection + lung necrosectomy 1 (4.1%). The postoperative course was uneventful in 23 patients; mean postoperative hospital stay was 6.3. One patient died because of sepsis.
Lung necrosectomy is a conservative, effective surgical treatment, which solves lung necrotizing infection avoiding resection of healthy lung parenchyma.
坏死性肺炎是肺实质的实变伴破坏和坏死，形成单个或多房性透光影。当抗生素治疗失败且临床病程无改善时，患者可能需要进行肺组织切除：肺段切除术、肺叶切除术或双肺叶切除术。我们对坏死性肺炎患儿采用了一种更为保守的手术方法，即肺坏死组织切除术：切除无活力的坏死组织，以保留更多健康且可能恢复的肺实质。本研究的目的是介绍我们在肺坏死组织切除术方面的经验结果。
回顾性分析坏死性肺炎患儿的临床病历。诊断基于体格检查、实验室数据和增强CT扫描。肺坏死组织切除技术包括用仔细的清创技术切除坏死组织；缝合漏气处和/或组织重叠缝合。
24例患儿接受了坏死性肺炎的手术治疗（18例女孩和6例男孩）。平均年龄为31.5±13.5个月。所有患者均有咳痰、发热和呼吸困难；胸部X线显示实变区域伴有肺实质内空洞，增强CT显示灌注不足。手术治疗包括：肺坏死组织切除术17例（70%）；肺叶切除术3例（12.5%）；楔形切除术2例（8.3%）；肺叶切除术+肺坏死组织切除术1例（4.1%），楔形切除术+肺坏死组织切除术1例（4.1%）。23例患者术后病程平稳；术后平均住院时间为6.3天。1例患者因败血症死亡。
肺坏死组织切除术是一种保守、有效的手术治疗方法，可解决肺部坏死性感染，避免切除健康的肺实质。
