Ito Atsushi, Takao Motoshi, Shimamoto Akira, Kaneda Shinji, Matsushita Kohei, Inoue Mikihiro, Uchida Keiichi
Department of Thoracic and Cardiovascular Surgery Mie University School of Medicine, Tsu, Japan.
Department of Gastrointestinal and Pediatric Surgery, Mie University School of Medicine, Tsu, Japan.
J Thorac Dis. 2019 Dec;11(12):5079-5086. doi: 10.21037/jtd.2019.12.14.
Although complete video-assisted thoracic surgery (C-VATS) has been demonstrated to have several advantages compared with conventional thoracotomy, there are few reports on the clinical feasibility of C-VATS for CPAM in infants.
We retrospectively evaluated 13 consecutive patients (neonates 4; infants 9) surgically treated for congenital pulmonary airway malformation (CPAM) from 1 January 2008 to 31 March 2017.
In the group of neonates, all 4 cases were prenatally diagnosed and they underwent semi-emergent surgery after birth due to respiratory failure. In the group of 9 infants, 5 cases were prenatally diagnosed and 4 cases were diagnosed at age >2.5 years due to symptoms associated with pulmonary cystic infection. Pulmonary resection consisted of the following: 8 lobectomies, 1 segmentectomy, 2 wedge resection, 1 fractionated lung resection and 1 lobectomy with segmentectomy. Overall, there were 9 thoracotomy and 4 thoracoscopic surgeries. Mean operation time was 162 min (range, 67-290 min) and blood loss was 21 mL (range, 0-74 mL) on average. There were no complications such as thoracic deformity or respiratory failure, however in 2 of those who underwent segmentectomy the cystic remnant remained. No statistically significant differences were observed between the thoracotomy Group and C-VATS group in terms of age and height at intervention, operation time, blood loss, postoperative day of drain removal, and length of hospital stay after surgery. However, only the average body weight was heavier in C-VATS group (P=0.03).
Since early surgical resection of asymptomatic CPAM is often recommended for the prevention of infections and the development of lung malignancy, we recommend performing surgery after the age of 1 year if the patient's condition is stable. Furthermore, C-VATS lobectomy may be feasible if they are older than 18 months or weigh more than 10 kg.
尽管完全电视胸腔镜手术（C-VATS）已被证明与传统开胸手术相比有诸多优势，但关于C-VATS应用于婴儿先天性肺气道畸形（CPAM）的临床可行性的报道较少。
我们回顾性评估了2008年1月1日至2017年3月31日期间接受手术治疗的13例连续性先天性肺气道畸形（CPAM）患者（新生儿4例；婴儿9例）。
在新生儿组中，所有4例均为产前诊断，出生后因呼吸衰竭接受半急诊手术。在9例婴儿组中，5例为产前诊断，4例因肺部囊性感染相关症状在2.5岁以上时被诊断。肺切除术包括：8例肺叶切除术、1例肺段切除术、2例楔形切除术、1例肺部分切除术和1例肺叶切除加肺段切除术。总体而言，有9例开胸手术和4例胸腔镜手术。平均手术时间为162分钟（范围67 - 290分钟），平均失血量为21毫升（范围0 - 74毫升）。无胸廓畸形或呼吸衰竭等并发症，但在接受肺段切除术的2例患者中，有囊性残余物残留。在干预时的年龄和身高、手术时间、失血量、术后拔管天数以及术后住院时间方面，开胸组和C-VATS组之间未观察到统计学上的显著差异。然而，仅C-VATS组的平均体重较重（P = 0.03）。
由于通常建议对无症状CPAM进行早期手术切除以预防感染和肺恶性肿瘤的发生，我们建议如果患者病情稳定，在1岁以后进行手术。此外，如果患者年龄超过18个月或体重超过10千克，C-VATS肺叶切除术可能是可行的。
