Huang Ting, Zhang Xiaole, Liang Liang, Tan Zheng, Gao Yue, Li Jianhua, Shu Qiang
the Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China.
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2018 May 25;47(3):272-277. doi: 10.3785/j.issn.1008-9292.2018.06.09.
To evaluate the feasibility of endoscopic lobectomy for pulmonary sequestration in children.
Clinical data of 47 children with pulmonary sequestration treated with endoscopic lobectomy from April 2015 to November 2017 were reviewed. According to the operation date, 19 children received operation from April 2015 to December 2016 were early group, and 23 children received operation from January 2017 to November 2017 were late group (5 children with lesions inside diaphragm were excluded). The operation time, intraoperative blood loss, retention time of drainage tube, length of hospital stay and incidence of complications were compared between two groups.
Among 47 children, endoscopic lobectomy was successfully completed in 45 children, and the rest 2 children were converted to thoracotomy. No death was observed. The operation time in late group was shorter than that in the early group (<0.05), and the intraoperative blood loss of the late group was less than that of early group (<0.05); while there were no significant differences in retention time of drainage tube and length of hospital stay between two groups (both >0.05). Postoperative complications occurred in 14 children, including 4 cases of pneumothorax, 8 cases of pleural effusion, 1 case of pulmonary infection, and 1 case of diaphragmatic hernia. The incidence rates of postoperative complications in late group and early group were 17.4% (4/23) and 42.1% (8/19), and the difference was not statistically significant(>0.05). During the follow-up (2-26 months), no relapse and thoracic collapes were observed, and CT examination found that the remaining lungs were well compensated in all children.
The endoscopic lobectomy is effective and safe with less trauma and bleeding, which is recommended for treatment of pulmonary sequestration in children.
评估小儿肺隔离症行胸腔镜肺叶切除术的可行性。
回顾性分析2015年4月至2017年11月接受胸腔镜肺叶切除术治疗的47例小儿肺隔离症患者的临床资料。按手术时间，将2015年4月至2016年12月接受手术的19例患儿作为早期组，2017年1月至2017年11月接受手术的23例患儿作为晚期组（排除5例膈内病变患儿）。比较两组手术时间、术中出血量、引流管留置时间、住院时间及并发症发生率。
47例患儿中，45例成功完成胸腔镜肺叶切除术，2例中转开胸。无死亡病例。晚期组手术时间短于早期组（<0.05），术中出血量少于早期组（<0.05）；两组引流管留置时间和住院时间比较，差异均无统计学意义（均>0.05）。术后14例患儿出现并发症，其中气胸4例，胸腔积液8例，肺部感染1例，膈疝1例。晚期组和早期组术后并发症发生率分别为17.4%（4/23）和42.1%（8/19），差异无统计学意义（>0.05）。随访（2～26个月）期间，无复发及胸廓塌陷，CT检查显示所有患儿余肺代偿良好。
胸腔镜肺叶切除术治疗小儿肺隔离症安全有效，创伤小、出血少，值得推荐。
