Pediatric Surgery Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy.
Pediatric Anesthesiology Unit, Department of Surgery, University Hospital of Padova, Padova, Italy.
Pediatr Pulmonol. 2021 Jan;56(1):196-202. doi: 10.1002/ppul.25138. Epub 2020 Nov 3.
Our aim is to compare thoracoscopy to thoracotomy in the treatment of congenital lung malformations (CLM) in children.
We report a retrospective monocentric cohort study. Patients treated at our Center for CLM (1991-2020) were divided in two groups: patients treated with video-assisted thoracoscopic surgery (VATS) and open thoracotomy (OT). Characteristics of the two groups were compared through statistical analysis (GraphPad Prism7). A p value less than .05 was considered statistically significant.
One hundred six patients were included: 58 in VATS group, 48 in OT group. Prenatal diagnosis was possible in 73.6%. The most frequent surgical procedures were lobectomy (43.4%) and sequestrectomy (22.6%). All VATS patients underwent lung exclusion, mostly by endobronchial blocker (69%). Mean operative time was 146.1 min (±52.04 SD) in VATS and 159.2 (±46.53 SD) in OT (p = .1973). Conversion to OT was necessary in 20.6% of VATS patients, but decreased in the last 5 years (6.2%). There were not any intraoperative complication. Respectively in VATS and OT group, length of stay (LOS) was 4.5 days ± 3.6 SD versus 7.7 ± 3.4 SD (p < .0001), chest tube duration 2.8 days ± 3.4 SD versus 3.7 ± 2.4 SD (p < .0001), antibiotic treatment duration 3.7 days ± 4.7 SD versus 5 ± 2.6 SD (p = .1196). Postoperative complications were described in 22.6%. The commonest histological diagnosis (40.6%) was congenital pulmonary airway malformation.
VATS resulted a feasible, effective and safe technique. Operative time and postoperative complications were similar in VATS and OT groups. VATS conversion rate decreased in time. VATS had a statistically significant shorter LOS and chest tube duration.
本研究旨在比较胸腔镜与开胸手术治疗儿童先天性肺畸形（CLM）的效果。
我们回顾性分析了单中心队列研究数据。将我院收治的先天性肺畸形（1991-2020 年）患者分为胸腔镜手术（VATS）组和开胸手术（OT）组。通过统计学分析（GraphPad Prism7）比较两组患者的特征。p 值<0.05 认为具有统计学意义。
共纳入 106 例患者，VATS 组 58 例，OT 组 48 例。73.6%的患者有产前诊断。最常见的手术方式为肺叶切除术（43.4%）和隔离肺切除术（22.6%）。所有 VATS 患者均行肺隔离术，主要采用支气管内封堵器（69%）。VATS 组的平均手术时间为 146.1 分钟（±52.04 标准差），OT 组为 159.2 分钟（±46.53 标准差）（p=0.1973）。VATS 组有 20.6%的患者需要中转开胸，但在最近 5 年中转率有所下降（6.2%）。两组均无术中并发症。VATS 组和 OT 组的住院时间分别为 4.5 天±3.6 标准差和 7.7 天±3.4 标准差（p<0.0001），胸腔引流管留置时间分别为 2.8 天±3.4 标准差和 3.7 天±2.4 标准差（p<0.0001），抗生素使用时间分别为 3.7 天±4.7 标准差和 5 天±2.6 标准差（p=0.1196）。术后并发症发生率为 22.6%。最常见的组织学诊断（40.6%）为先天性肺气道畸形。
胸腔镜手术是一种可行、有效、安全的技术。VATS 组与 OT 组的手术时间和术后并发症无显著差异。VATS 中转率呈下降趋势。VATS 组的住院时间和胸腔引流管留置时间更短。
